| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,277 |
2,273 |
$200K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,822 |
1,818 |
$117K |
| D0120 |
Periodic oral evaluation - established patient |
1,590 |
1,587 |
$109K |
| D0210 |
Intraoral - complete series of radiographic images |
1,422 |
1,418 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,491 |
3,486 |
$47K |
| D1120 |
Prophylaxis - child |
967 |
966 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,649 |
1,646 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
501 |
227 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
395 |
207 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,380 |
2,264 |
$18K |
| D0350 |
|
1,558 |
584 |
$15K |
| D9430 |
|
82 |
80 |
$3K |
| D1351 |
Sealant - per tooth |
112 |
27 |
$2K |