| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,768 |
3,530 |
$153K |
| D1351 |
Sealant - per tooth |
1,062 |
595 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
3,258 |
3,044 |
$90K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,557 |
2,352 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,435 |
1,366 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,575 |
1,488 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
294 |
200 |
$21K |
| D1206 |
Topical application of fluoride varnish |
776 |
776 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
3,521 |
3,297 |
$20K |
| D1110 |
Prophylaxis - adult |
321 |
315 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,024 |
2,829 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
440 |
405 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
318 |
310 |
$5K |
| D4341 |
|
22 |
13 |
$4K |
| D0272 |
Bitewings - two radiographic images |
364 |
339 |
$3K |
| D0330 |
Panoramic radiographic image |
154 |
140 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
47 |
40 |
$2K |
| D9110 |
|
18 |
16 |
$990.00 |
| D0270 |
|
84 |
83 |
$451.80 |