| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,542 |
3,373 |
$167K |
| D0120 |
Periodic oral evaluation - established patient |
4,422 |
4,299 |
$121K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,450 |
3,411 |
$70K |
| D1120 |
Prophylaxis - child |
1,947 |
1,935 |
$70K |
| D0272 |
Bitewings - two radiographic images |
3,174 |
3,075 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
970 |
897 |
$43K |
| D1351 |
Sealant - per tooth |
1,210 |
389 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
135 |
94 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
130 |
95 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
610 |
543 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
58 |
53 |
$1K |
| D0274 |
Bitewings - four radiographic images |
50 |
43 |
$1K |