| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
949 |
880 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,047 |
975 |
$26K |
| D1206 |
Topical application of fluoride varnish |
928 |
856 |
$22K |
| D9110 |
|
126 |
121 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
312 |
296 |
$6K |
| D0274 |
Bitewings - four radiographic images |
302 |
276 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
80 |
61 |
$4K |
| D1351 |
Sealant - per tooth |
64 |
32 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
677 |
627 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
130 |
126 |
$3K |
| D1110 |
Prophylaxis - adult |
132 |
123 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
22 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
542 |
502 |
$2K |
| D0272 |
Bitewings - two radiographic images |
183 |
174 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
99 |
90 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
12 |
$462.75 |
| D1330 |
|
22 |
21 |
$0.00 |