| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,001 |
982 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,392 |
1,366 |
$20K |
| D1120 |
Prophylaxis - child |
726 |
713 |
$16K |
| D1110 |
Prophylaxis - adult |
300 |
294 |
$10K |
| D0272 |
Bitewings - two radiographic images |
1,019 |
1,002 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
164 |
68 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
181 |
177 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
741 |
726 |
$6K |
| D1351 |
Sealant - per tooth |
243 |
71 |
$5K |
| D1999 |
|
274 |
245 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,226 |
642 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
50 |
26 |
$2K |
| D1206 |
Topical application of fluoride varnish |
124 |
121 |
$2K |