| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
14,461 |
14,026 |
$535K |
| D1206 |
Topical application of fluoride varnish |
14,534 |
14,081 |
$336K |
| D0120 |
Periodic oral evaluation - established patient |
12,667 |
12,336 |
$323K |
| D1351 |
Sealant - per tooth |
3,702 |
2,124 |
$188K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,137 |
2,002 |
$41K |
| D1354 |
|
221 |
108 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
114 |
46 |
$2K |
| D0272 |
Bitewings - two radiographic images |
268 |
216 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
316 |
253 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
285 |
238 |
$725.68 |
| D0601 |
|
8,388 |
8,256 |
$0.00 |
| D0603 |
|
1,118 |
1,111 |
$0.00 |
| D0602 |
|
2,102 |
2,074 |
$0.00 |