| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,942 |
1,845 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
2,567 |
2,464 |
$64K |
| D1351 |
Sealant - per tooth |
561 |
298 |
$41K |
| D1110 |
Prophylaxis - adult |
1,301 |
1,260 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,296 |
1,222 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,886 |
1,818 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
571 |
424 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,168 |
1,129 |
$25K |
| D9110 |
|
437 |
417 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
162 |
118 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
946 |
912 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
213 |
205 |
$3K |
| D8670 |
Periodic orthodontic treatment visit |
12 |
12 |
$3K |
| D0330 |
Panoramic radiographic image |
113 |
101 |
$2K |
| D0272 |
Bitewings - two radiographic images |
158 |
141 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
251 |
245 |
$1K |
| D0270 |
|
32 |
31 |
$166.20 |