| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
337 |
328 |
$7K |
| D1206 |
Topical application of fluoride varnish |
445 |
424 |
$5K |
| D1120 |
Prophylaxis - child |
247 |
237 |
$5K |
| D0274 |
Bitewings - four radiographic images |
302 |
292 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
653 |
624 |
$5K |
| D1110 |
Prophylaxis - adult |
181 |
175 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
758 |
529 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
204 |
191 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
153 |
148 |
$2K |
| D1351 |
Sealant - per tooth |
133 |
30 |
$2K |
| D0272 |
Bitewings - two radiographic images |
155 |
151 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
45 |
28 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$457.20 |
| D1999 |
|
321 |
263 |
$0.00 |