| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,504 |
4,325 |
$178K |
| D0120 |
Periodic oral evaluation - established patient |
4,530 |
4,301 |
$122K |
| D1206 |
Topical application of fluoride varnish |
3,998 |
3,835 |
$101K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
972 |
674 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,810 |
1,693 |
$29K |
| D1110 |
Prophylaxis - adult |
527 |
482 |
$18K |
| D9110 |
|
288 |
270 |
$15K |
| D1351 |
Sealant - per tooth |
282 |
128 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
700 |
672 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
2,420 |
2,297 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
133 |
99 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,633 |
1,544 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
209 |
162 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
276 |
268 |
$7K |
| D0272 |
Bitewings - two radiographic images |
339 |
329 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
155 |
147 |
$2K |
| D0330 |
Panoramic radiographic image |
43 |
43 |
$1K |
| D0270 |
|
97 |
95 |
$532.00 |
| D1999 |
|
16 |
16 |
$0.00 |