| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,723 |
6,540 |
$275K |
| D0120 |
Periodic oral evaluation - established patient |
6,755 |
6,567 |
$190K |
| D1351 |
Sealant - per tooth |
2,176 |
1,385 |
$176K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,503 |
6,342 |
$169K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
893 |
598 |
$60K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
801 |
583 |
$58K |
| D0274 |
Bitewings - four radiographic images |
3,184 |
3,088 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,416 |
1,360 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
5,442 |
5,264 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,941 |
4,777 |
$20K |
| D0330 |
Panoramic radiographic image |
480 |
459 |
$11K |
| D0272 |
Bitewings - two radiographic images |
1,058 |
1,026 |
$11K |
| D1110 |
Prophylaxis - adult |
231 |
223 |
$9K |
| D1354 |
|
163 |
129 |
$4K |
| D0999 |
Unspecified diagnostic procedure, by report |
29 |
27 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
151 |
150 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
45 |
38 |
$1K |
| D2140 |
|
13 |
12 |
$524.45 |
| D1999 |
|
467 |
296 |
$0.00 |