| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,034 |
3,867 |
$183K |
| D0120 |
Periodic oral evaluation - established patient |
5,658 |
5,368 |
$121K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,651 |
3,462 |
$68K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,334 |
970 |
$67K |
| D1120 |
Prophylaxis - child |
2,129 |
2,007 |
$61K |
| D0274 |
Bitewings - four radiographic images |
1,770 |
1,672 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
1,221 |
1,121 |
$42K |
| D0330 |
Panoramic radiographic image |
812 |
764 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,425 |
1,335 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
805 |
756 |
$22K |
| D1351 |
Sealant - per tooth |
766 |
170 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
425 |
394 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,168 |
1,071 |
$13K |
| D2330 |
|
34 |
25 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
181 |
139 |
$1K |
| D1999 |
|
114 |
98 |
$0.00 |