| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,258 |
2,196 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
2,857 |
2,777 |
$77K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,835 |
1,778 |
$47K |
| D9110 |
|
669 |
660 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,260 |
1,233 |
$23K |
| D1351 |
Sealant - per tooth |
262 |
161 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,916 |
2,825 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,265 |
2,191 |
$10K |
| D1110 |
Prophylaxis - adult |
247 |
246 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
197 |
194 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
65 |
57 |
$4K |
| D0272 |
Bitewings - two radiographic images |
173 |
171 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
14 |
$582.40 |
| D1206 |
Topical application of fluoride varnish |
15 |
15 |
$364.00 |
| D0140 |
Limited oral evaluation - problem focused |
15 |
13 |
$210.60 |
| D9995 |
|
14 |
12 |
$144.17 |