| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,610 |
2,546 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
3,631 |
3,555 |
$85K |
| D1206 |
Topical application of fluoride varnish |
2,344 |
2,292 |
$47K |
| D1120 |
Prophylaxis - child |
1,437 |
1,407 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,603 |
1,556 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,606 |
1,568 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
420 |
291 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
229 |
148 |
$16K |
| D0330 |
Panoramic radiographic image |
384 |
374 |
$13K |
| D1351 |
Sealant - per tooth |
475 |
159 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
393 |
380 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
938 |
896 |
$10K |
| D0272 |
Bitewings - two radiographic images |
520 |
513 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
813 |
521 |
$6K |