| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,348 |
1,322 |
$34K |
| D1120 |
Prophylaxis - child |
1,049 |
1,029 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,337 |
1,307 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
206 |
130 |
$19K |
| D1110 |
Prophylaxis - adult |
460 |
452 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,083 |
663 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
853 |
827 |
$12K |
| D1351 |
Sealant - per tooth |
367 |
91 |
$10K |
| D0330 |
Panoramic radiographic image |
186 |
182 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
218 |
213 |
$9K |
| D0274 |
Bitewings - four radiographic images |
218 |
214 |
$6K |
| D0272 |
Bitewings - two radiographic images |
234 |
229 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$413.28 |
| D9986 |
|
47 |
47 |
$0.00 |
| D1999 |
|
174 |
157 |
$0.00 |