| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,012 |
2,961 |
$144K |
| D0120 |
Periodic oral evaluation - established patient |
3,873 |
3,806 |
$107K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,746 |
3,687 |
$105K |
| D1110 |
Prophylaxis - adult |
1,578 |
1,550 |
$103K |
| D0274 |
Bitewings - four radiographic images |
1,542 |
1,513 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
1,814 |
1,775 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,683 |
1,625 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
448 |
437 |
$24K |
| D0330 |
Panoramic radiographic image |
327 |
321 |
$22K |
| D0272 |
Bitewings - two radiographic images |
561 |
552 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
120 |
66 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
60 |
30 |
$6K |
| D1206 |
Topical application of fluoride varnish |
151 |
151 |
$4K |
| D1351 |
Sealant - per tooth |
58 |
21 |
$2K |