| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,279 |
1,183 |
$228K |
| D0120 |
Periodic oral evaluation - established patient |
1,509 |
1,451 |
$148K |
| D0140 |
Limited oral evaluation - problem focused |
416 |
411 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
472 |
455 |
$73K |
| D4910 |
|
277 |
273 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
488 |
476 |
$47K |
| D1120 |
Prophylaxis - child |
339 |
330 |
$43K |
| D0274 |
Bitewings - four radiographic images |
628 |
601 |
$31K |
| D1206 |
Topical application of fluoride varnish |
571 |
559 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
127 |
86 |
$22K |
| D0330 |
Panoramic radiographic image |
153 |
149 |
$19K |
| D1351 |
Sealant - per tooth |
290 |
80 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
149 |
139 |
$10K |
| D0272 |
Bitewings - two radiographic images |
95 |
91 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
337 |
319 |
$3K |