| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,402 |
1,332 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
1,695 |
1,618 |
$48K |
| D1351 |
Sealant - per tooth |
387 |
233 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,342 |
1,275 |
$35K |
| D0274 |
Bitewings - four radiographic images |
940 |
889 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
103 |
87 |
$9K |
| D0330 |
Panoramic radiographic image |
300 |
292 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
108 |
83 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
263 |
247 |
$6K |
| D1110 |
Prophylaxis - adult |
82 |
82 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
468 |
448 |
$3K |
| D9110 |
|
28 |
28 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
205 |
197 |
$1K |
| D0272 |
Bitewings - two radiographic images |
137 |
130 |
$1K |