| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,888 |
1,863 |
$72K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,617 |
2,568 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,928 |
1,878 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
481 |
477 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
838 |
831 |
$21K |
| D1351 |
Sealant - per tooth |
651 |
118 |
$13K |
| D1120 |
Prophylaxis - child |
356 |
349 |
$9K |
| D0274 |
Bitewings - four radiographic images |
559 |
554 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
59 |
37 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
58 |
28 |
$3K |
| D0330 |
Panoramic radiographic image |
365 |
363 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
283 |
279 |
$3K |
| D0272 |
Bitewings - two radiographic images |
151 |
146 |
$2K |
| D1999 |
|
146 |
137 |
$0.00 |