| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,455 |
4,398 |
$271K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,004 |
995 |
$248K |
| D0120 |
Periodic oral evaluation - established patient |
6,947 |
6,855 |
$207K |
| D1120 |
Prophylaxis - child |
3,611 |
3,557 |
$156K |
| D1351 |
Sealant - per tooth |
4,333 |
783 |
$144K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,136 |
6,047 |
$140K |
| D0274 |
Bitewings - four radiographic images |
3,536 |
3,490 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,457 |
1,432 |
$76K |
| D0330 |
Panoramic radiographic image |
1,743 |
1,716 |
$75K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
642 |
379 |
$63K |
| D1206 |
Topical application of fluoride varnish |
2,178 |
2,154 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
3,631 |
3,567 |
$36K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
192 |
123 |
$30K |
| D1330 |
|
4,360 |
4,296 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,011 |
2,967 |
$21K |
| D0272 |
Bitewings - two radiographic images |
508 |
504 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
111 |
107 |
$5K |