| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,988 |
7,965 |
$232K |
| D1206 |
Topical application of fluoride varnish |
11,906 |
11,868 |
$212K |
| D0120 |
Periodic oral evaluation - established patient |
10,514 |
10,480 |
$182K |
| D1110 |
Prophylaxis - adult |
3,976 |
3,961 |
$157K |
| D1351 |
Sealant - per tooth |
3,259 |
1,098 |
$98K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,151 |
973 |
$71K |
| D0272 |
Bitewings - two radiographic images |
2,929 |
2,920 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
578 |
475 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
560 |
550 |
$39K |
| D9920 |
|
645 |
645 |
$38K |
| D0330 |
Panoramic radiographic image |
415 |
415 |
$21K |
| D9630 |
|
554 |
551 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
309 |
297 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$297.96 |