| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,987 |
3,915 |
$160K |
| D0120 |
Periodic oral evaluation - established patient |
3,466 |
3,412 |
$96K |
| D1206 |
Topical application of fluoride varnish |
3,745 |
3,679 |
$96K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
364 |
269 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,092 |
1,064 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
374 |
357 |
$8K |
| D0274 |
Bitewings - four radiographic images |
234 |
231 |
$4K |
| D1351 |
Sealant - per tooth |
45 |
27 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
353 |
337 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
200 |
185 |
$908.36 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
13 |
$709.55 |
| D1999 |
|
18 |
16 |
$0.00 |