| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
496 |
490 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
751 |
737 |
$23K |
| D1120 |
Prophylaxis - child |
425 |
419 |
$20K |
| D0330 |
Panoramic radiographic image |
325 |
317 |
$19K |
| D0272 |
Bitewings - two radiographic images |
887 |
877 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,084 |
1,066 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
676 |
669 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
341 |
341 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,135 |
964 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
63 |
46 |
$3K |
| D1351 |
Sealant - per tooth |
141 |
30 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
37 |
24 |
$2K |