| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,163 |
4,905 |
$177K |
| D0120 |
Periodic oral evaluation - established patient |
9,131 |
8,742 |
$163K |
| D1206 |
Topical application of fluoride varnish |
6,618 |
6,328 |
$135K |
| D1120 |
Prophylaxis - child |
5,057 |
4,825 |
$134K |
| D0330 |
Panoramic radiographic image |
2,785 |
2,640 |
$127K |
| D0274 |
Bitewings - four radiographic images |
3,292 |
3,126 |
$74K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,801 |
3,623 |
$53K |
| D1351 |
Sealant - per tooth |
2,301 |
654 |
$52K |
| D0272 |
Bitewings - two radiographic images |
2,819 |
2,675 |
$47K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
523 |
381 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,202 |
1,116 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
264 |
178 |
$14K |
| D9110 |
|
172 |
166 |
$6K |
| D1999 |
|
274 |
243 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
109 |
65 |
$5K |