| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,495 |
1,454 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
2,609 |
2,553 |
$73K |
| D0274 |
Bitewings - four radiographic images |
2,008 |
1,961 |
$59K |
| D1120 |
Prophylaxis - child |
1,267 |
1,242 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,154 |
3,086 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
426 |
196 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
2,757 |
2,693 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,516 |
2,461 |
$28K |
| D0330 |
Panoramic radiographic image |
302 |
287 |
$11K |
| D0272 |
Bitewings - two radiographic images |
521 |
514 |
$11K |
| D1351 |
Sealant - per tooth |
381 |
67 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
275 |
261 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
72 |
54 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
18 |
18 |
$2K |
| D0602 |
|
1,243 |
1,214 |
$0.00 |
| D0601 |
|
1,271 |
1,251 |
$0.00 |
| D0603 |
|
240 |
238 |
$0.00 |