| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,086 |
1,963 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,809 |
2,663 |
$64K |
| D1110 |
Prophylaxis - adult |
1,288 |
1,220 |
$55K |
| D1206 |
Topical application of fluoride varnish |
1,844 |
1,743 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
371 |
233 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,033 |
959 |
$22K |
| D0274 |
Bitewings - four radiographic images |
642 |
602 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
404 |
373 |
$12K |
| D1351 |
Sealant - per tooth |
282 |
75 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
295 |
275 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
37 |
26 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
29 |
27 |
$808.86 |
| D0230 |
Intraoral - periapical each additional radiographic image |
35 |
26 |
$354.95 |
| D9986 |
|
26 |
26 |
$0.00 |