| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
936 |
921 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
893 |
879 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
869 |
854 |
$22K |
| D1351 |
Sealant - per tooth |
351 |
132 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
625 |
604 |
$13K |
| D0274 |
Bitewings - four radiographic images |
822 |
801 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,359 |
1,316 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
98 |
57 |
$7K |
| D1110 |
Prophylaxis - adult |
241 |
232 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
113 |
41 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,300 |
1,250 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
163 |
155 |
$2K |
| D0272 |
Bitewings - two radiographic images |
231 |
228 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
12 |
$3.80 |
| D1999 |
|
105 |
68 |
$0.00 |