| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
689 |
665 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
951 |
889 |
$24K |
| D0145 |
Oral evaluation for a patient under three years of age |
154 |
150 |
$21K |
| D0274 |
Bitewings - four radiographic images |
576 |
547 |
$17K |
| D1120 |
Prophylaxis - child |
506 |
472 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,475 |
1,008 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,261 |
1,152 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
319 |
307 |
$12K |
| D1351 |
Sealant - per tooth |
409 |
55 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
630 |
587 |
$8K |
| D1206 |
Topical application of fluoride varnish |
432 |
415 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
64 |
29 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
25 |
$2K |
| D0272 |
Bitewings - two radiographic images |
64 |
57 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$315.59 |
| D0602 |
|
740 |
718 |
$27.06 |
| D0603 |
|
632 |
604 |
$9.30 |
| D1999 |
|
57 |
41 |
$0.00 |
| D0601 |
|
30 |
29 |
$0.00 |