| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,514 |
10,419 |
$271K |
| D1110 |
Prophylaxis - adult |
6,553 |
6,494 |
$253K |
| D1120 |
Prophylaxis - child |
6,118 |
6,076 |
$170K |
| D1206 |
Topical application of fluoride varnish |
10,333 |
10,241 |
$165K |
| D0330 |
Panoramic radiographic image |
2,669 |
2,632 |
$155K |
| D0274 |
Bitewings - four radiographic images |
4,034 |
3,984 |
$130K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,152 |
812 |
$120K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,541 |
2,494 |
$110K |
| D0170 |
|
2,974 |
2,535 |
$83K |
| D0140 |
Limited oral evaluation - problem focused |
2,248 |
2,157 |
$80K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
714 |
523 |
$55K |
| D1351 |
Sealant - per tooth |
1,788 |
362 |
$50K |
| D9110 |
|
1,005 |
976 |
$45K |
| D0272 |
Bitewings - two radiographic images |
2,163 |
2,143 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
658 |
631 |
$10K |
| D4355 |
|
53 |
53 |
$3K |
| D2332 |
|
18 |
12 |
$2K |
| D2335 |
|
13 |
12 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$1K |
| D2330 |
|
18 |
12 |
$1K |