| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,124 |
6,859 |
$94K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,150 |
4,969 |
$79K |
| D1351 |
Sealant - per tooth |
7,528 |
2,312 |
$73K |
| D1354 |
|
9,074 |
2,496 |
$62K |
| D1206 |
Topical application of fluoride varnish |
7,587 |
7,329 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,599 |
6,660 |
$42K |
| D0272 |
Bitewings - two radiographic images |
4,880 |
4,703 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
7,064 |
6,803 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,508 |
1,447 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
2,326 |
2,259 |
$20K |
| D1110 |
Prophylaxis - adult |
286 |
275 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
37 |
25 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
12 |
$2K |