| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,333 |
1,169 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
2,182 |
1,818 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,626 |
2,152 |
$47K |
| D1351 |
Sealant - per tooth |
1,266 |
232 |
$26K |
| D1120 |
Prophylaxis - child |
818 |
633 |
$24K |
| D0274 |
Bitewings - four radiographic images |
288 |
266 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
68 |
25 |
$7K |
| D0330 |
Panoramic radiographic image |
162 |
136 |
$6K |
| D0272 |
Bitewings - two radiographic images |
283 |
228 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
233 |
198 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
80 |
57 |
$2K |
| D1999 |
|
44 |
29 |
$0.00 |