| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
648 |
632 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
542 |
518 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
494 |
488 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
316 |
314 |
$11K |
| D1120 |
Prophylaxis - child |
423 |
403 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
374 |
363 |
$4K |
| D0274 |
Bitewings - four radiographic images |
383 |
362 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
94 |
92 |
$2K |
| D1351 |
Sealant - per tooth |
149 |
20 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
58 |
37 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
325 |
314 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
38 |
19 |
$1K |
| D0330 |
Panoramic radiographic image |
152 |
151 |
$1K |
| D0601 |
|
144 |
131 |
$990.00 |
| D1206 |
Topical application of fluoride varnish |
83 |
75 |
$980.50 |
| D0230 |
Intraoral - periapical each additional radiographic image |
175 |
151 |
$542.85 |
| D9920 |
|
16 |
16 |
$268.00 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$88.55 |