| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
842 |
792 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
745 |
702 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
482 |
455 |
$12K |
| D1351 |
Sealant - per tooth |
97 |
39 |
$6K |
| D0274 |
Bitewings - four radiographic images |
308 |
291 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
199 |
191 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
644 |
602 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
61 |
39 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
549 |
515 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
66 |
60 |
$907.20 |
| D0272 |
Bitewings - two radiographic images |
93 |
91 |
$827.20 |
| D1110 |
Prophylaxis - adult |
16 |
15 |
$304.80 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$107.40 |