| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
5,131 |
4,933 |
$116K |
| D1110 |
Prophylaxis - adult |
1,922 |
1,837 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
2,915 |
2,810 |
$87K |
| D1120 |
Prophylaxis - child |
2,058 |
1,977 |
$77K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
415 |
189 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,429 |
1,375 |
$53K |
| D9630 |
|
2,447 |
2,364 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,532 |
1,470 |
$35K |
| D1354 |
|
1,272 |
446 |
$27K |
| D0603 |
|
2,047 |
1,971 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
156 |
89 |
$12K |
| D0601 |
|
826 |
793 |
$10K |
| D0330 |
Panoramic radiographic image |
123 |
119 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
181 |
172 |
$7K |
| D1310 |
|
137 |
134 |
$5K |
| D1330 |
|
137 |
134 |
$3K |
| D1351 |
Sealant - per tooth |
96 |
24 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
53 |
49 |
$2K |