| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,131 |
1,112 |
$88K |
| D1120 |
Prophylaxis - child |
1,358 |
1,337 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
2,127 |
2,096 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,605 |
2,577 |
$20K |
| D9999 |
Unspecified adjunctive procedure, by report |
252 |
252 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,227 |
2,487 |
$13K |
| D1351 |
Sealant - per tooth |
1,648 |
361 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
88 |
44 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
2,557 |
2,491 |
$6K |
| D0272 |
Bitewings - two radiographic images |
1,203 |
1,177 |
$5K |
| D1330 |
|
2,631 |
2,596 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
234 |
231 |
$855.36 |
| D0350 |
|
342 |
338 |
$665.76 |
| D0601 |
|
2,084 |
2,047 |
$634.26 |
| D0190 |
|
1,059 |
1,033 |
$533.00 |
| D1999 |
|
1,054 |
1,029 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
18 |
18 |
$0.00 |