| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,016 |
3,819 |
$162K |
| D0120 |
Periodic oral evaluation - established patient |
5,492 |
5,237 |
$150K |
| D4341 |
|
606 |
345 |
$109K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,497 |
3,320 |
$90K |
| D0274 |
Bitewings - four radiographic images |
3,390 |
3,252 |
$58K |
| D1351 |
Sealant - per tooth |
671 |
290 |
$49K |
| D1110 |
Prophylaxis - adult |
1,207 |
1,163 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
5,845 |
5,553 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,206 |
1,156 |
$26K |
| D0330 |
Panoramic radiographic image |
1,055 |
1,014 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,171 |
4,848 |
$22K |
| D9110 |
|
278 |
262 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
703 |
674 |
$11K |
| D0272 |
Bitewings - two radiographic images |
467 |
436 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14 |
14 |
$852.30 |
| D1999 |
|
177 |
163 |
$0.00 |
| D0190 |
|
133 |
127 |
$0.00 |