| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
3,030 |
2,396 |
$98K |
| D1120 |
Prophylaxis - child |
3,102 |
2,852 |
$78K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,692 |
2,481 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,596 |
1,458 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,317 |
1,193 |
$30K |
| D0330 |
Panoramic radiographic image |
581 |
538 |
$24K |
| D1351 |
Sealant - per tooth |
800 |
120 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
172 |
97 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
119 |
83 |
$9K |
| D0272 |
Bitewings - two radiographic images |
407 |
391 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
403 |
359 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$888.64 |
| D0230 |
Intraoral - periapical each additional radiographic image |
44 |
28 |
$410.68 |
| D1999 |
|
33 |
27 |
$0.00 |