| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
564 |
535 |
$11K |
| D1120 |
Prophylaxis - child |
449 |
439 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
178 |
128 |
$8K |
| D0274 |
Bitewings - four radiographic images |
524 |
497 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,063 |
1,013 |
$8K |
| D1110 |
Prophylaxis - adult |
319 |
300 |
$8K |
| D1206 |
Topical application of fluoride varnish |
576 |
561 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,219 |
866 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
398 |
397 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
103 |
58 |
$4K |
| D0272 |
Bitewings - two radiographic images |
262 |
255 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
139 |
131 |
$2K |
| D1351 |
Sealant - per tooth |
104 |
27 |
$2K |
| D1330 |
|
24 |
19 |
$0.00 |