| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9110 |
|
2,850 |
2,733 |
$136K |
| D1351 |
Sealant - per tooth |
3,226 |
445 |
$69K |
| D1110 |
Prophylaxis - adult |
1,579 |
1,522 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
2,276 |
2,231 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,122 |
2,999 |
$54K |
| D9630 |
|
964 |
928 |
$41K |
| D1120 |
Prophylaxis - child |
1,477 |
1,429 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
732 |
678 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,885 |
1,780 |
$15K |
| D0274 |
Bitewings - four radiographic images |
670 |
645 |
$9K |
| D1999 |
|
313 |
284 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,574 |
1,501 |
$4K |
| D0272 |
Bitewings - two radiographic images |
151 |
145 |
$1K |