| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,996 |
2,883 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
3,223 |
3,111 |
$89K |
| D1351 |
Sealant - per tooth |
888 |
572 |
$66K |
| D1110 |
Prophylaxis - adult |
1,261 |
1,221 |
$55K |
| D1206 |
Topical application of fluoride varnish |
2,093 |
2,005 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
732 |
531 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,939 |
1,793 |
$44K |
| D0330 |
Panoramic radiographic image |
1,200 |
1,096 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,529 |
1,472 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
3,731 |
3,503 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
742 |
724 |
$19K |
| D9110 |
|
296 |
258 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,685 |
2,564 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
679 |
653 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
140 |
100 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
565 |
496 |
$5K |
| D0272 |
Bitewings - two radiographic images |
128 |
126 |
$1K |