| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,826 |
3,824 |
$123K |
| D0120 |
Periodic oral evaluation - established patient |
3,581 |
3,578 |
$79K |
| D1206 |
Topical application of fluoride varnish |
2,916 |
2,913 |
$68K |
| D0272 |
Bitewings - two radiographic images |
818 |
818 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
921 |
921 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
92 |
74 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
230 |
230 |
$5K |
| D0274 |
Bitewings - four radiographic images |
148 |
145 |
$3K |
| D1110 |
Prophylaxis - adult |
65 |
65 |
$3K |
| D1351 |
Sealant - per tooth |
15 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
41 |
41 |
$1K |
| D1999 |
|
251 |
244 |
$0.00 |