| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,906 |
1,883 |
$120K |
| D0120 |
Periodic oral evaluation - established patient |
3,040 |
2,990 |
$91K |
| D1206 |
Topical application of fluoride varnish |
1,984 |
1,952 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
356 |
190 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,864 |
1,840 |
$43K |
| D1120 |
Prophylaxis - child |
969 |
959 |
$42K |
| D0330 |
Panoramic radiographic image |
828 |
818 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,579 |
1,563 |
$36K |
| D1351 |
Sealant - per tooth |
839 |
124 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,554 |
2,489 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
539 |
526 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
361 |
359 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,925 |
1,900 |
$13K |
| D1330 |
|
1,364 |
1,340 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$3K |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$225.00 |