| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,323 |
1,292 |
$56K |
| D1206 |
Topical application of fluoride varnish |
2,310 |
2,262 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,852 |
1,808 |
$44K |
| D0330 |
Panoramic radiographic image |
859 |
827 |
$39K |
| D1120 |
Prophylaxis - child |
921 |
892 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
377 |
201 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
845 |
819 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
183 |
100 |
$11K |
| D0272 |
Bitewings - two radiographic images |
479 |
467 |
$8K |
| D9110 |
|
142 |
138 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
413 |
392 |
$5K |
| D1351 |
Sealant - per tooth |
108 |
26 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
15 |
$1K |