| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,929 |
2,812 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
4,443 |
4,261 |
$77K |
| D1999 |
|
3,540 |
3,244 |
$67K |
| D1110 |
Prophylaxis - adult |
2,005 |
1,906 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,372 |
3,258 |
$48K |
| D0330 |
Panoramic radiographic image |
1,008 |
964 |
$46K |
| D1351 |
Sealant - per tooth |
1,513 |
379 |
$34K |
| D0272 |
Bitewings - two radiographic images |
1,873 |
1,783 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
281 |
167 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
346 |
236 |
$21K |
| D0274 |
Bitewings - four radiographic images |
618 |
606 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
189 |
96 |
$10K |
| D2140 |
|
195 |
118 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
319 |
297 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
269 |
263 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
114 |
109 |
$1K |
| D1330 |
|
23 |
19 |
$0.00 |