| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
1,448 |
1,418 |
$37K |
| D1110 |
Prophylaxis - adult |
1,136 |
1,108 |
$36K |
| D0330 |
Panoramic radiographic image |
763 |
755 |
$25K |
| D1351 |
Sealant - per tooth |
495 |
100 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
849 |
838 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
853 |
827 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
215 |
148 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
369 |
357 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
61 |
46 |
$5K |
| D1330 |
|
618 |
612 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
485 |
465 |
$3K |
| D9920 |
|
104 |
104 |
$3K |
| D1310 |
|
528 |
525 |
$3K |
| D9110 |
|
62 |
61 |
$2K |
| D1120 |
Prophylaxis - child |
71 |
70 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
59 |
58 |
$1K |
| D0601 |
|
108 |
108 |
$720.00 |
| D0603 |
|
49 |
49 |
$290.00 |
| D9994 |
|
57 |
57 |
$0.00 |