| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,152 |
2,061 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
2,047 |
1,971 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,682 |
1,603 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
368 |
263 |
$26K |
| D1351 |
Sealant - per tooth |
345 |
213 |
$25K |
| D0274 |
Bitewings - four radiographic images |
783 |
750 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,871 |
1,775 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,637 |
1,553 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
241 |
235 |
$5K |
| D0272 |
Bitewings - two radiographic images |
454 |
434 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
55 |
52 |
$3K |
| D1206 |
Topical application of fluoride varnish |
127 |
126 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
218 |
203 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
27 |
26 |
$2K |
| D1110 |
Prophylaxis - adult |
30 |
29 |
$1K |
| D0330 |
Panoramic radiographic image |
37 |
37 |
$687.54 |
| D9310 |
|
12 |
12 |
$205.20 |
| D0270 |
|
15 |
15 |
$84.00 |