| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,088 |
2,925 |
$149K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,480 |
5,229 |
$143K |
| D1110 |
Prophylaxis - adult |
2,849 |
2,717 |
$136K |
| D1351 |
Sealant - per tooth |
5,460 |
1,096 |
$106K |
| D0274 |
Bitewings - four radiographic images |
3,333 |
3,159 |
$94K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,667 |
5,388 |
$87K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,185 |
745 |
$84K |
| D0330 |
Panoramic radiographic image |
1,529 |
1,483 |
$70K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
764 |
514 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,652 |
3,570 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
4,429 |
4,181 |
$40K |
| D0272 |
Bitewings - two radiographic images |
782 |
771 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
480 |
466 |
$13K |
| D2394 |
|
144 |
93 |
$12K |
| D9248 |
|
30 |
25 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
82 |
81 |
$3K |
| D9986 |
|
116 |
109 |
$0.00 |