| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
949 |
944 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,224 |
1,218 |
$29K |
| D0274 |
Bitewings - four radiographic images |
853 |
849 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
469 |
176 |
$23K |
| D1351 |
Sealant - per tooth |
873 |
136 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
466 |
461 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
959 |
946 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
931 |
926 |
$7K |
| D9920 |
|
71 |
70 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
96 |
65 |
$6K |
| D1120 |
Prophylaxis - child |
164 |
163 |
$5K |
| D1330 |
|
674 |
671 |
$3K |
| D0272 |
Bitewings - two radiographic images |
81 |
80 |
$1K |