| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,611 |
1,544 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
1,204 |
1,157 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
847 |
809 |
$21K |
| D0330 |
Panoramic radiographic image |
173 |
158 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
222 |
212 |
$3K |
| D0274 |
Bitewings - four radiographic images |
170 |
166 |
$3K |
| D0272 |
Bitewings - two radiographic images |
252 |
236 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
374 |
361 |
$2K |
| D1351 |
Sealant - per tooth |
26 |
17 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
314 |
303 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13 |
13 |
$818.55 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
33 |
29 |
$647.70 |