| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,967 |
2,923 |
$109K |
| D0120 |
Periodic oral evaluation - established patient |
5,749 |
5,641 |
$107K |
| D1120 |
Prophylaxis - child |
2,984 |
2,918 |
$83K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,595 |
3,516 |
$57K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
572 |
359 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,544 |
1,517 |
$39K |
| D0272 |
Bitewings - two radiographic images |
1,005 |
976 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,101 |
1,054 |
$11K |
| D0330 |
Panoramic radiographic image |
133 |
132 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
55 |
54 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
55 |
53 |
$1K |
| D1351 |
Sealant - per tooth |
49 |
12 |
$1K |