| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,311 |
3,283 |
$78K |
| D1110 |
Prophylaxis - adult |
1,781 |
1,758 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,798 |
2,774 |
$55K |
| D1120 |
Prophylaxis - child |
1,567 |
1,560 |
$50K |
| D0272 |
Bitewings - two radiographic images |
2,498 |
2,481 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
350 |
153 |
$19K |
| D0330 |
Panoramic radiographic image |
443 |
438 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
229 |
222 |
$5K |
| D1351 |
Sealant - per tooth |
175 |
43 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
16 |
$2K |