| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,721 |
3,604 |
$154K |
| D0120 |
Periodic oral evaluation - established patient |
3,690 |
3,573 |
$104K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,579 |
3,465 |
$94K |
| D1351 |
Sealant - per tooth |
1,231 |
632 |
$88K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
398 |
341 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
531 |
394 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,690 |
1,631 |
$31K |
| D1110 |
Prophylaxis - adult |
668 |
655 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,215 |
1,175 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
3,395 |
3,265 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,027 |
2,890 |
$13K |
| D0272 |
Bitewings - two radiographic images |
985 |
944 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
170 |
168 |
$3K |