| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,337 |
1,296 |
$54K |
| D1120 |
Prophylaxis - child |
1,072 |
1,046 |
$50K |
| D1206 |
Topical application of fluoride varnish |
1,446 |
1,410 |
$45K |
| D1110 |
Prophylaxis - adult |
624 |
607 |
$44K |
| D0330 |
Panoramic radiographic image |
445 |
440 |
$41K |
| D0272 |
Bitewings - two radiographic images |
896 |
870 |
$31K |
| D0274 |
Bitewings - four radiographic images |
501 |
486 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
343 |
337 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
105 |
92 |
$13K |
| D1351 |
Sealant - per tooth |
160 |
42 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
171 |
162 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
94 |
83 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
34 |
26 |
$3K |