| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,824 |
2,733 |
$115K |
| D0120 |
Periodic oral evaluation - established patient |
2,927 |
2,836 |
$82K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,483 |
2,397 |
$64K |
| D1351 |
Sealant - per tooth |
481 |
338 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
545 |
391 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,506 |
1,449 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,105 |
1,051 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
3,246 |
3,075 |
$19K |
| D1110 |
Prophylaxis - adult |
450 |
437 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
787 |
769 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,684 |
2,552 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
370 |
359 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
189 |
157 |
$8K |
| D0272 |
Bitewings - two radiographic images |
357 |
326 |
$3K |
| D0270 |
|
265 |
254 |
$1K |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$338.00 |
| D1999 |
|
14 |
12 |
$0.00 |