| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,837 |
1,778 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,169 |
2,101 |
$49K |
| D1110 |
Prophylaxis - adult |
761 |
744 |
$46K |
| D1120 |
Prophylaxis - child |
1,049 |
1,004 |
$44K |
| D0274 |
Bitewings - four radiographic images |
515 |
493 |
$11K |
| D1351 |
Sealant - per tooth |
241 |
48 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
610 |
587 |
$5K |
| D1330 |
|
859 |
831 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
72 |
67 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
493 |
481 |
$3K |
| D0272 |
Bitewings - two radiographic images |
190 |
183 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
15 |
$2K |
| D3120 |
|
41 |
25 |
$1K |