| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,117 |
3,075 |
$137K |
| D0120 |
Periodic oral evaluation - established patient |
3,855 |
3,795 |
$115K |
| D1206 |
Topical application of fluoride varnish |
3,720 |
3,649 |
$89K |
| D1110 |
Prophylaxis - adult |
1,346 |
1,329 |
$84K |
| D1351 |
Sealant - per tooth |
2,457 |
472 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
524 |
294 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,285 |
1,268 |
$29K |
| D0330 |
Panoramic radiographic image |
640 |
626 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,021 |
1,011 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
408 |
401 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,838 |
1,786 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,622 |
1,588 |
$18K |
| D1330 |
|
2,240 |
2,196 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
91 |
52 |
$12K |
| D0272 |
Bitewings - two radiographic images |
616 |
602 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$1K |