| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,376 |
5,084 |
$210K |
| D0120 |
Periodic oral evaluation - established patient |
5,465 |
5,180 |
$146K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,907 |
3,763 |
$99K |
| D1351 |
Sealant - per tooth |
1,126 |
610 |
$98K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
566 |
397 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,629 |
1,595 |
$39K |
| D1110 |
Prophylaxis - adult |
880 |
841 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,516 |
1,460 |
$27K |
| D4341 |
|
119 |
56 |
$19K |
| D1206 |
Topical application of fluoride varnish |
789 |
708 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
405 |
300 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
3,194 |
3,012 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
665 |
640 |
$17K |
| D0330 |
Panoramic radiographic image |
555 |
547 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,879 |
2,695 |
$12K |
| D0272 |
Bitewings - two radiographic images |
872 |
803 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
462 |
445 |
$8K |
| D9110 |
|
147 |
139 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
24 |
$2K |
| D1330 |
|
917 |
830 |
$0.00 |
| D1999 |
|
17 |
13 |
$0.00 |