| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,169 |
1,077 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
1,441 |
1,266 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,297 |
1,204 |
$32K |
| D1351 |
Sealant - per tooth |
631 |
125 |
$24K |
| D0274 |
Bitewings - four radiographic images |
554 |
514 |
$19K |
| D1120 |
Prophylaxis - child |
258 |
238 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
43 |
29 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
38 |
24 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
77 |
75 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
39 |
39 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
122 |
114 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
67 |
65 |
$501.42 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$422.73 |
| D0602 |
|
322 |
299 |
$0.00 |
| D0603 |
|
181 |
160 |
$0.00 |
| D0601 |
|
16 |
16 |
$0.00 |