| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
742 |
644 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
666 |
581 |
$16K |
| D1206 |
Topical application of fluoride varnish |
546 |
451 |
$12K |
| D0274 |
Bitewings - four radiographic images |
518 |
458 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
348 |
305 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
189 |
187 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
95 |
48 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
594 |
530 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
553 |
446 |
$2K |
| D1110 |
Prophylaxis - adult |
69 |
62 |
$2K |
| D1351 |
Sealant - per tooth |
33 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
135 |
107 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
85 |
84 |
$890.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
30 |
15 |
$771.25 |