| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,550 |
1,524 |
$76K |
| D1120 |
Prophylaxis - child |
769 |
761 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,479 |
1,454 |
$34K |
| D0274 |
Bitewings - four radiographic images |
973 |
960 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,141 |
1,129 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
129 |
80 |
$10K |
| D1351 |
Sealant - per tooth |
181 |
52 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
174 |
170 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
413 |
382 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
137 |
135 |
$5K |
| D9110 |
|
36 |
30 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$929.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
76 |
52 |
$924.00 |
| D1999 |
|
414 |
362 |
$0.00 |