| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,358 |
3,224 |
$183K |
| D0120 |
Periodic oral evaluation - established patient |
5,829 |
5,660 |
$164K |
| D1206 |
Topical application of fluoride varnish |
6,473 |
6,248 |
$159K |
| D1120 |
Prophylaxis - child |
3,864 |
3,733 |
$147K |
| D0330 |
Panoramic radiographic image |
1,511 |
1,367 |
$97K |
| D0274 |
Bitewings - four radiographic images |
2,417 |
2,339 |
$90K |
| D0220 |
Intraoral - periapical first radiographic image |
2,862 |
2,728 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,186 |
1,112 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,416 |
1,476 |
$35K |
| D1351 |
Sealant - per tooth |
946 |
284 |
$30K |
| D0272 |
Bitewings - two radiographic images |
997 |
976 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
547 |
516 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
328 |
317 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
65 |
40 |
$8K |
| D0190 |
|
289 |
284 |
$6K |