| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,109 |
6,723 |
$186K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,547 |
9,925 |
$178K |
| D1110 |
Prophylaxis - adult |
3,315 |
3,094 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
7,069 |
6,653 |
$120K |
| D1351 |
Sealant - per tooth |
4,294 |
1,143 |
$100K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,914 |
2,739 |
$84K |
| D0272 |
Bitewings - two radiographic images |
3,984 |
3,768 |
$72K |
| D0210 |
Intraoral - complete series of radiographic images |
1,805 |
1,615 |
$62K |
| D0274 |
Bitewings - four radiographic images |
2,359 |
2,198 |
$62K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
823 |
615 |
$38K |
| D0330 |
Panoramic radiographic image |
890 |
806 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
638 |
526 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,370 |
1,285 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
898 |
829 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
55 |
55 |
$2K |