| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,144 |
1,084 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
1,710 |
1,616 |
$36K |
| D1206 |
Topical application of fluoride varnish |
1,231 |
1,165 |
$23K |
| D1120 |
Prophylaxis - child |
676 |
635 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
267 |
255 |
$18K |
| D1351 |
Sealant - per tooth |
585 |
151 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
128 |
77 |
$10K |
| D0274 |
Bitewings - four radiographic images |
169 |
162 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
86 |
50 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
118 |
108 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
222 |
216 |
$2K |
| D9920 |
|
157 |
134 |
$1K |
| D0272 |
Bitewings - two radiographic images |
41 |
39 |
$967.59 |
| D1999 |
|
41 |
34 |
$30.00 |