| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,056 |
9,899 |
$450K |
| D0120 |
Periodic oral evaluation - established patient |
13,093 |
12,861 |
$392K |
| D1206 |
Topical application of fluoride varnish |
14,868 |
14,616 |
$370K |
| D1110 |
Prophylaxis - adult |
4,586 |
4,491 |
$277K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,390 |
949 |
$175K |
| D0330 |
Panoramic radiographic image |
1,937 |
1,906 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,161 |
1,146 |
$61K |
| D0274 |
Bitewings - four radiographic images |
2,675 |
2,629 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
586 |
473 |
$58K |
| D1330 |
|
7,828 |
7,676 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
1,049 |
1,020 |
$47K |
| D0272 |
Bitewings - two radiographic images |
2,465 |
2,429 |
$38K |
| D1351 |
Sealant - per tooth |
979 |
215 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
537 |
528 |
$5K |