| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,889 |
2,760 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
5,025 |
4,794 |
$89K |
| D1206 |
Topical application of fluoride varnish |
4,507 |
4,293 |
$68K |
| D1120 |
Prophylaxis - child |
2,265 |
2,152 |
$60K |
| D0274 |
Bitewings - four radiographic images |
1,531 |
1,459 |
$35K |
| D0272 |
Bitewings - two radiographic images |
503 |
477 |
$9K |
| D1351 |
Sealant - per tooth |
427 |
89 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
129 |
62 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
37 |
25 |
$2K |
| D0330 |
Panoramic radiographic image |
51 |
44 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
111 |
103 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
39 |
39 |
$965.40 |
| D1999 |
|
1,607 |
1,326 |
$0.00 |