| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,193 |
1,095 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,177 |
1,080 |
$32K |
| D1351 |
Sealant - per tooth |
317 |
222 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,148 |
1,054 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
143 |
114 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
200 |
159 |
$7K |
| D0274 |
Bitewings - four radiographic images |
484 |
435 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
290 |
245 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
1,145 |
1,016 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
961 |
861 |
$4K |
| D1110 |
Prophylaxis - adult |
101 |
97 |
$4K |
| D0330 |
Panoramic radiographic image |
206 |
176 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
169 |
132 |
$2K |
| D0272 |
Bitewings - two radiographic images |
227 |
212 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
114 |
109 |
$2K |