| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,911 |
2,877 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
3,704 |
3,669 |
$79K |
| D0274 |
Bitewings - four radiographic images |
1,959 |
1,941 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,973 |
2,948 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
432 |
334 |
$36K |
| D1110 |
Prophylaxis - adult |
1,035 |
1,019 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,378 |
1,365 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
454 |
454 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
491 |
487 |
$16K |
| D0330 |
Panoramic radiographic image |
246 |
241 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
80 |
66 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
487 |
475 |
$6K |
| D1351 |
Sealant - per tooth |
58 |
15 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
40 |
40 |
$990.12 |