| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,967 |
5,923 |
$102K |
| D1120 |
Prophylaxis - child |
3,390 |
3,374 |
$98K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,664 |
4,628 |
$85K |
| D1110 |
Prophylaxis - adult |
1,929 |
1,906 |
$75K |
| D0210 |
Intraoral - complete series of radiographic images |
772 |
748 |
$44K |
| D0272 |
Bitewings - two radiographic images |
1,326 |
1,326 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
350 |
185 |
$18K |
| D2140 |
|
197 |
127 |
$12K |
| D1351 |
Sealant - per tooth |
260 |
57 |
$7K |
| D1206 |
Topical application of fluoride varnish |
541 |
539 |
$6K |
| D0330 |
Panoramic radiographic image |
44 |
44 |
$2K |