| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
1,089 |
175 |
$48K |
| D1120 |
Prophylaxis - child |
1,134 |
1,070 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,270 |
1,203 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,121 |
1,041 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,284 |
1,202 |
$29K |
| D1110 |
Prophylaxis - adult |
526 |
499 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,270 |
1,189 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
146 |
99 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,293 |
919 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
299 |
273 |
$12K |
| D0330 |
Panoramic radiographic image |
122 |
119 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
155 |
146 |
$7K |
| D1206 |
Topical application of fluoride varnish |
182 |
179 |
$5K |
| D9110 |
|
36 |
34 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
13 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
50 |
40 |
$1K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$379.60 |
| D1999 |
|
433 |
301 |
$0.00 |