| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,482 |
3,409 |
$147K |
| D0120 |
Periodic oral evaluation - established patient |
4,030 |
3,950 |
$120K |
| D0274 |
Bitewings - four radiographic images |
3,047 |
2,979 |
$111K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,443 |
857 |
$95K |
| D0210 |
Intraoral - complete series of radiographic images |
1,000 |
982 |
$74K |
| D1206 |
Topical application of fluoride varnish |
4,013 |
3,930 |
$65K |
| D1351 |
Sealant - per tooth |
1,871 |
715 |
$64K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
820 |
548 |
$61K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,431 |
1,260 |
$32K |
| D1120 |
Prophylaxis - child |
574 |
563 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
197 |
188 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$213.16 |