| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2394 |
|
148 |
39 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,498 |
1,445 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
505 |
482 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,829 |
1,767 |
$15K |
| D0274 |
Bitewings - four radiographic images |
788 |
763 |
$14K |
| D1120 |
Prophylaxis - child |
512 |
497 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,608 |
1,538 |
$11K |
| D1110 |
Prophylaxis - adult |
370 |
353 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
657 |
646 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
68 |
28 |
$7K |
| D1351 |
Sealant - per tooth |
248 |
64 |
$6K |
| D0272 |
Bitewings - two radiographic images |
180 |
178 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
39 |
39 |
$640.76 |