| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,062 |
6,708 |
$175K |
| D1206 |
Topical application of fluoride varnish |
7,902 |
7,535 |
$122K |
| D1120 |
Prophylaxis - child |
3,793 |
3,611 |
$96K |
| D1110 |
Prophylaxis - adult |
2,464 |
2,347 |
$89K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
866 |
500 |
$85K |
| D0272 |
Bitewings - two radiographic images |
1,136 |
1,077 |
$20K |
| D0274 |
Bitewings - four radiographic images |
328 |
311 |
$10K |
| D1351 |
Sealant - per tooth |
191 |
51 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
82 |
79 |
$3K |
| D0330 |
Panoramic radiographic image |
38 |
37 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
12 |
$196.56 |