| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,373 |
1,257 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
1,256 |
1,145 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,307 |
1,197 |
$32K |
| D1351 |
Sealant - per tooth |
443 |
216 |
$20K |
| D0274 |
Bitewings - four radiographic images |
790 |
729 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
526 |
503 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
629 |
537 |
$9K |
| D0330 |
Panoramic radiographic image |
434 |
412 |
$8K |
| D4341 |
|
31 |
15 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
907 |
598 |
$7K |
| D1110 |
Prophylaxis - adult |
168 |
155 |
$4K |
| D8999 |
|
98 |
98 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
316 |
296 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
725 |
636 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
64 |
46 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
13 |
$866.70 |
| D1354 |
|
37 |
31 |
$727.65 |