| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
761 |
758 |
$30K |
| D1120 |
Prophylaxis - child |
526 |
523 |
$27K |
| D0330 |
Panoramic radiographic image |
262 |
257 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
600 |
600 |
$25K |
| D0274 |
Bitewings - four radiographic images |
446 |
446 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
107 |
87 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
134 |
107 |
$20K |
| D1110 |
Prophylaxis - adult |
234 |
230 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
236 |
229 |
$17K |
| D1351 |
Sealant - per tooth |
231 |
86 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
375 |
368 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
213 |
187 |
$8K |
| D0272 |
Bitewings - two radiographic images |
179 |
177 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
15 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
49 |
49 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$948.00 |