| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,123 |
5,980 |
$231K |
| D0120 |
Periodic oral evaluation - established patient |
6,865 |
6,719 |
$215K |
| D1351 |
Sealant - per tooth |
6,295 |
1,540 |
$203K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,719 |
987 |
$181K |
| D1206 |
Topical application of fluoride varnish |
6,105 |
5,965 |
$114K |
| D1110 |
Prophylaxis - adult |
2,099 |
2,044 |
$104K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,040 |
603 |
$99K |
| D3120 |
|
3,451 |
1,520 |
$78K |
| D0274 |
Bitewings - four radiographic images |
2,300 |
2,248 |
$76K |
| D0272 |
Bitewings - two radiographic images |
2,445 |
2,399 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
902 |
859 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,754 |
1,709 |
$31K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
260 |
168 |
$27K |
| D0330 |
Panoramic radiographic image |
544 |
527 |
$23K |
| D2140 |
|
19 |
13 |
$2K |