| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,198 |
3,501 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
2,860 |
2,734 |
$78K |
| D1206 |
Topical application of fluoride varnish |
2,727 |
2,101 |
$51K |
| D0272 |
Bitewings - two radiographic images |
2,045 |
1,640 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,442 |
840 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,148 |
1,113 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
147 |
72 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
69 |
45 |
$6K |
| D1351 |
Sealant - per tooth |
168 |
58 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
182 |
176 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
26 |
$1K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$395.60 |
| D1999 |
|
15 |
15 |
$0.00 |