| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,453 |
3,346 |
$141K |
| D0120 |
Periodic oral evaluation - established patient |
3,479 |
3,327 |
$95K |
| D1206 |
Topical application of fluoride varnish |
1,688 |
1,655 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
873 |
845 |
$23K |
| D0274 |
Bitewings - four radiographic images |
833 |
801 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,977 |
1,878 |
$11K |
| D1110 |
Prophylaxis - adult |
239 |
223 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
118 |
97 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,679 |
1,582 |
$7K |
| D0272 |
Bitewings - two radiographic images |
659 |
634 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
283 |
273 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
77 |
67 |
$4K |
| D0330 |
Panoramic radiographic image |
93 |
85 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
52 |
52 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
12 |
$226.80 |
| D1330 |
|
174 |
158 |
$0.00 |
| D0350 |
|
48 |
46 |
$0.00 |