| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
319 |
315 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
361 |
354 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
598 |
585 |
$8K |
| D1351 |
Sealant - per tooth |
289 |
72 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
59 |
57 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
530 |
383 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
446 |
433 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
36 |
12 |
$3K |
| D0274 |
Bitewings - four radiographic images |
86 |
85 |
$3K |
| D1110 |
Prophylaxis - adult |
45 |
43 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
59 |
58 |
$2K |
| D0272 |
Bitewings - two radiographic images |
48 |
48 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$918.32 |
| D1999 |
|
383 |
336 |
$0.00 |
| D0602 |
|
197 |
194 |
$0.00 |
| D0603 |
|
308 |
307 |
$0.00 |
| D0601 |
|
15 |
14 |
$0.00 |