| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,260 |
2,197 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
2,054 |
1,995 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,213 |
2,149 |
$56K |
| D1351 |
Sealant - per tooth |
585 |
262 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,144 |
1,955 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,047 |
1,986 |
$11K |
| D0274 |
Bitewings - four radiographic images |
645 |
627 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
136 |
133 |
$3K |
| D0272 |
Bitewings - two radiographic images |
148 |
144 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
13 |
$740.40 |