| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,087 |
1,982 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
2,852 |
2,793 |
$77K |
| D1120 |
Prophylaxis - child |
1,399 |
1,394 |
$48K |
| D0272 |
Bitewings - two radiographic images |
1,621 |
1,602 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,452 |
1,443 |
$30K |
| D0330 |
Panoramic radiographic image |
615 |
571 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
841 |
683 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
72 |
42 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
121 |
111 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
44 |
36 |
$1K |
| D1351 |
Sealant - per tooth |
36 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
26 |
26 |
$607.25 |
| D0274 |
Bitewings - four radiographic images |
47 |
38 |
$374.00 |
| D0140 |
Limited oral evaluation - problem focused |
30 |
25 |
$180.00 |