| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,166 |
2,008 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
2,259 |
2,074 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,167 |
1,090 |
$29K |
| D1351 |
Sealant - per tooth |
357 |
194 |
$23K |
| D0274 |
Bitewings - four radiographic images |
1,090 |
1,008 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,883 |
1,713 |
$10K |
| D1110 |
Prophylaxis - adult |
390 |
351 |
$9K |
| D9110 |
|
143 |
127 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,740 |
1,592 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
89 |
68 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
174 |
168 |
$4K |
| D0272 |
Bitewings - two radiographic images |
54 |
54 |
$507.60 |