| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,310 |
1,214 |
$32K |
| D1999 |
|
1,685 |
1,442 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,516 |
1,394 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,944 |
1,780 |
$25K |
| D1110 |
Prophylaxis - adult |
522 |
471 |
$17K |
| D0330 |
Panoramic radiographic image |
275 |
254 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,153 |
1,039 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
996 |
836 |
$9K |
| D0272 |
Bitewings - two radiographic images |
542 |
483 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
262 |
246 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
53 |
38 |
$4K |
| D0274 |
Bitewings - four radiographic images |
192 |
169 |
$4K |
| D1351 |
Sealant - per tooth |
54 |
12 |
$1K |