| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,236 |
1,214 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
1,835 |
1,805 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
3,334 |
3,177 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,234 |
2,189 |
$8K |
| D0274 |
Bitewings - four radiographic images |
1,365 |
1,339 |
$7K |
| D1110 |
Prophylaxis - adult |
813 |
800 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,566 |
2,388 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
748 |
706 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
268 |
253 |
$2K |
| D1351 |
Sealant - per tooth |
322 |
92 |
$2K |
| D0272 |
Bitewings - two radiographic images |
467 |
459 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
89 |
41 |
$837.78 |
| D0330 |
Panoramic radiographic image |
39 |
35 |
$171.17 |
| D1206 |
Topical application of fluoride varnish |
41 |
39 |
$150.50 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$116.50 |
| D0604 |
|
38 |
36 |
$110.74 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
35 |
13 |
$57.15 |
| D1999 |
|
328 |
306 |
$26.57 |
| D0601 |
|
159 |
157 |
$0.00 |