| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,548 |
1,537 |
$132K |
| D0120 |
Periodic oral evaluation - established patient |
1,377 |
1,365 |
$76K |
| D9430 |
|
1,155 |
1,000 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,106 |
2,089 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
396 |
396 |
$23K |
| D4910 |
|
122 |
122 |
$9K |
| D0272 |
Bitewings - two radiographic images |
528 |
518 |
$6K |
| D2330 |
|
65 |
27 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
88 |
55 |
$5K |
| D1120 |
Prophylaxis - child |
159 |
155 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
290 |
284 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
225 |
221 |
$2K |
| D1351 |
Sealant - per tooth |
67 |
13 |
$1K |
| D1330 |
|
21 |
21 |
$0.00 |