| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
854 |
821 |
$46K |
| D1206 |
Topical application of fluoride varnish |
1,175 |
1,141 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
233 |
143 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
606 |
575 |
$25K |
| D0274 |
Bitewings - four radiographic images |
709 |
676 |
$24K |
| D0330 |
Panoramic radiographic image |
394 |
370 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
853 |
838 |
$23K |
| D1120 |
Prophylaxis - child |
454 |
445 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
810 |
747 |
$13K |
| D1351 |
Sealant - per tooth |
445 |
99 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
699 |
383 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
77 |
55 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
82 |
80 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
66 |
62 |
$2K |
| D0272 |
Bitewings - two radiographic images |
40 |
40 |
$1K |
| D1999 |
|
349 |
294 |
$0.00 |