| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,906 |
11,863 |
$530K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,034 |
11,987 |
$334K |
| D0120 |
Periodic oral evaluation - established patient |
9,256 |
9,224 |
$312K |
| D0272 |
Bitewings - two radiographic images |
6,383 |
6,360 |
$196K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,571 |
2,555 |
$161K |
| D1351 |
Sealant - per tooth |
3,665 |
1,318 |
$141K |
| D0330 |
Panoramic radiographic image |
1,377 |
1,367 |
$114K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
959 |
487 |
$103K |
| D0220 |
Intraoral - periapical first radiographic image |
2,237 |
2,209 |
$41K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
254 |
158 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,429 |
1,141 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
59 |
39 |
$5K |
| D1354 |
|
33 |
12 |
$444.30 |