| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,009 |
1,791 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
2,546 |
2,271 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
760 |
576 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,146 |
1,146 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,349 |
1,074 |
$23K |
| D0274 |
Bitewings - four radiographic images |
1,123 |
1,077 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,369 |
2,201 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,021 |
1,804 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
317 |
237 |
$16K |
| D1110 |
Prophylaxis - adult |
525 |
491 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
300 |
286 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
186 |
172 |
$4K |
| D0272 |
Bitewings - two radiographic images |
226 |
205 |
$2K |
| D1351 |
Sealant - per tooth |
99 |
42 |
$2K |
| D0602 |
|
300 |
219 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
56 |
42 |
$1K |
| D0330 |
Panoramic radiographic image |
62 |
58 |
$1K |
| D0601 |
|
161 |
122 |
$0.00 |
| D1330 |
|
54 |
51 |
$0.00 |
| D0603 |
|
75 |
73 |
$0.00 |