| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
903 |
873 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,539 |
1,492 |
$42K |
| D0274 |
Bitewings - four radiographic images |
984 |
944 |
$32K |
| D1120 |
Prophylaxis - child |
706 |
684 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,725 |
1,665 |
$24K |
| D1351 |
Sealant - per tooth |
712 |
191 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
91 |
54 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
47 |
27 |
$5K |
| D0272 |
Bitewings - two radiographic images |
193 |
191 |
$4K |
| D0603 |
|
806 |
786 |
$0.00 |
| D0602 |
|
371 |
365 |
$0.00 |
| D0601 |
|
149 |
143 |
$0.00 |