| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,543 |
4,473 |
$351K |
| D1120 |
Prophylaxis - child |
4,779 |
4,699 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
511 |
498 |
$57K |
| D1351 |
Sealant - per tooth |
2,011 |
387 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
535 |
236 |
$50K |
| D0272 |
Bitewings - two radiographic images |
3,401 |
3,340 |
$42K |
| D1206 |
Topical application of fluoride varnish |
5,006 |
4,923 |
$39K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
659 |
316 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,026 |
1,011 |
$19K |
| D0330 |
Panoramic radiographic image |
352 |
347 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
657 |
645 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
339 |
296 |
$3K |
| D1110 |
Prophylaxis - adult |
164 |
159 |
$1K |
| D1999 |
|
33 |
29 |
$1K |
| D2140 |
|
15 |
14 |
$778.97 |