| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
1,782 |
264 |
$33K |
| D1110 |
Prophylaxis - adult |
760 |
725 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,244 |
1,179 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
915 |
864 |
$14K |
| D1120 |
Prophylaxis - child |
547 |
520 |
$12K |
| D0274 |
Bitewings - four radiographic images |
534 |
500 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
172 |
81 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
157 |
149 |
$3K |
| D0272 |
Bitewings - two radiographic images |
85 |
83 |
$1K |
| D0601 |
|
175 |
167 |
$555.00 |
| D0603 |
|
99 |
95 |
$350.00 |
| D0220 |
Intraoral - periapical first radiographic image |
16 |
14 |
$153.45 |