| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,601 |
9,589 |
$429K |
| D0120 |
Periodic oral evaluation - established patient |
10,687 |
9,659 |
$296K |
| D1351 |
Sealant - per tooth |
1,979 |
1,022 |
$190K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,953 |
5,427 |
$154K |
| D0220 |
Intraoral - periapical first radiographic image |
8,118 |
7,207 |
$47K |
| D0272 |
Bitewings - two radiographic images |
4,110 |
3,650 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,730 |
6,887 |
$31K |
| D0330 |
Panoramic radiographic image |
1,040 |
1,017 |
$27K |
| D9310 |
|
523 |
471 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
159 |
146 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
12 |
$946.40 |