| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,457 |
3,427 |
$104K |
| D1206 |
Topical application of fluoride varnish |
5,146 |
5,093 |
$94K |
| D1110 |
Prophylaxis - adult |
2,195 |
2,152 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
4,664 |
4,610 |
$84K |
| D9920 |
|
772 |
761 |
$51K |
| D9990 |
|
2,060 |
2,004 |
$43K |
| D0272 |
Bitewings - two radiographic images |
1,013 |
1,001 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
884 |
820 |
$18K |
| D9110 |
|
341 |
337 |
$14K |
| D9994 |
|
442 |
423 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
133 |
64 |
$11K |
| D9992 |
|
1,415 |
1,270 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
494 |
425 |
$10K |
| D0330 |
Panoramic radiographic image |
211 |
200 |
$8K |
| D0274 |
Bitewings - four radiographic images |
369 |
367 |
$7K |
| D9310 |
|
100 |
97 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
173 |
173 |
$7K |
| D1351 |
Sealant - per tooth |
289 |
66 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
461 |
381 |
$4K |
| D9996 |
|
110 |
105 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
12 |
$2K |