| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,941 |
1,916 |
$88K |
| D1206 |
Topical application of fluoride varnish |
2,954 |
2,907 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
2,619 |
2,578 |
$61K |
| D0274 |
Bitewings - four radiographic images |
2,063 |
2,034 |
$59K |
| D1120 |
Prophylaxis - child |
1,344 |
1,315 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
418 |
228 |
$41K |
| D0330 |
Panoramic radiographic image |
649 |
635 |
$39K |
| D1351 |
Sealant - per tooth |
1,028 |
221 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
482 |
468 |
$18K |
| D0272 |
Bitewings - two radiographic images |
609 |
604 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
822 |
803 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
530 |
392 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
34 |
27 |
$3K |