| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,114 |
1,073 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
2,095 |
2,023 |
$56K |
| D1351 |
Sealant - per tooth |
2,129 |
260 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,563 |
1,511 |
$47K |
| D1120 |
Prophylaxis - child |
1,097 |
1,063 |
$37K |
| D1206 |
Topical application of fluoride varnish |
1,963 |
1,918 |
$27K |
| D0145 |
Oral evaluation for a patient under three years of age |
149 |
145 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
126 |
70 |
$11K |
| D0272 |
Bitewings - two radiographic images |
359 |
350 |
$8K |
| D0330 |
Panoramic radiographic image |
226 |
218 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
98 |
93 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
45 |
43 |
$1K |
| D0601 |
|
2,147 |
2,118 |
$48.01 |
| D0602 |
|
159 |
153 |
$27.00 |