| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,474 |
1,413 |
$114K |
| D0120 |
Periodic oral evaluation - established patient |
1,670 |
1,606 |
$81K |
| D0274 |
Bitewings - four radiographic images |
1,001 |
925 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
346 |
313 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
202 |
189 |
$17K |
| D0999 |
Unspecified diagnostic procedure, by report |
136 |
120 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
72 |
68 |
$8K |
| D1206 |
Topical application of fluoride varnish |
884 |
835 |
$4K |
| D1351 |
Sealant - per tooth |
68 |
53 |
$986.70 |
| D0220 |
Intraoral - periapical first radiographic image |
1,208 |
1,129 |
$488.97 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,609 |
1,227 |
$0.00 |
| D0603 |
|
1,034 |
979 |
$0.00 |
| D1330 |
|
673 |
609 |
$0.00 |
| D0601 |
|
15 |
15 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
139 |
139 |
$0.00 |