| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,506 |
3,202 |
$161K |
| D0120 |
Periodic oral evaluation - established patient |
5,027 |
4,813 |
$136K |
| D1120 |
Prophylaxis - child |
2,748 |
2,710 |
$95K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,608 |
3,566 |
$72K |
| D0272 |
Bitewings - two radiographic images |
3,115 |
2,868 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
3,969 |
3,656 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,199 |
903 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,842 |
2,359 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
366 |
244 |
$26K |
| D1351 |
Sealant - per tooth |
309 |
97 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
107 |
66 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
239 |
231 |
$3K |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$291.48 |