| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,558 |
3,477 |
$125K |
| D0120 |
Periodic oral evaluation - established patient |
4,533 |
4,418 |
$77K |
| D1206 |
Topical application of fluoride varnish |
4,046 |
3,934 |
$62K |
| D0274 |
Bitewings - four radiographic images |
1,819 |
1,765 |
$36K |
| D1120 |
Prophylaxis - child |
1,046 |
1,011 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
919 |
826 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
64 |
43 |
$6K |
| D0330 |
Panoramic radiographic image |
213 |
199 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
54 |
30 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
145 |
138 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
62 |
54 |
$3K |
| D1351 |
Sealant - per tooth |
75 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
84 |
84 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
18 |
13 |
$1K |
| D1352 |
|
29 |
15 |
$242.32 |
| D0603 |
|
13 |
13 |
$65.00 |
| D0602 |
|
13 |
13 |
$65.00 |
| D0601 |
|
14 |
14 |
$65.00 |
| D1999 |
|
940 |
792 |
$0.00 |