| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,133 |
1,847 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
1,383 |
1,137 |
$43K |
| D1206 |
Topical application of fluoride varnish |
1,335 |
1,175 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,001 |
883 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
94 |
52 |
$9K |
| D0330 |
Panoramic radiographic image |
256 |
199 |
$8K |
| D8670 |
Periodic orthodontic treatment visit |
86 |
82 |
$7K |
| D0272 |
Bitewings - two radiographic images |
419 |
353 |
$6K |
| D1351 |
Sealant - per tooth |
186 |
26 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
328 |
300 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
55 |
27 |
$4K |
| D0274 |
Bitewings - four radiographic images |
59 |
54 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
127 |
108 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
40 |
37 |
$950.91 |
| D1330 |
|
19 |
18 |
$0.00 |