| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,861 |
4,809 |
$182K |
| D0120 |
Periodic oral evaluation - established patient |
7,905 |
7,795 |
$150K |
| D1206 |
Topical application of fluoride varnish |
7,245 |
7,145 |
$118K |
| D1120 |
Prophylaxis - child |
2,674 |
2,624 |
$78K |
| D0274 |
Bitewings - four radiographic images |
2,341 |
2,318 |
$60K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
343 |
236 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
264 |
174 |
$15K |
| D1351 |
Sealant - per tooth |
351 |
50 |
$7K |
| D0272 |
Bitewings - two radiographic images |
350 |
345 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
471 |
428 |
$5K |
| D0330 |
Panoramic radiographic image |
65 |
63 |
$3K |