| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,174 |
2,964 |
$141K |
| D0120 |
Periodic oral evaluation - established patient |
3,502 |
3,236 |
$72K |
| D0274 |
Bitewings - four radiographic images |
1,939 |
1,797 |
$61K |
| D1351 |
Sealant - per tooth |
1,408 |
235 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,836 |
1,641 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
978 |
913 |
$27K |
| D1120 |
Prophylaxis - child |
851 |
782 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
668 |
632 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
246 |
159 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
648 |
595 |
$6K |
| D0272 |
Bitewings - two radiographic images |
67 |
55 |
$1K |
| D0270 |
|
13 |
13 |
$259.38 |