| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
1,954 |
1,922 |
$49K |
| D1110 |
Prophylaxis - adult |
658 |
652 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
621 |
612 |
$34K |
| D2750 |
|
69 |
43 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
929 |
911 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
194 |
129 |
$27K |
| D1120 |
Prophylaxis - child |
588 |
570 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
302 |
293 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,148 |
1,111 |
$12K |
| D0330 |
Panoramic radiographic image |
256 |
256 |
$12K |
| D0274 |
Bitewings - four radiographic images |
458 |
454 |
$11K |
| D2950 |
|
104 |
69 |
$9K |
| D1351 |
Sealant - per tooth |
150 |
25 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
794 |
777 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
40 |
$2K |
| D1330 |
|
177 |
170 |
$1K |
| D0272 |
Bitewings - two radiographic images |
38 |
38 |
$606.66 |