| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,903 |
1,849 |
$81K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,757 |
2,684 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
2,344 |
2,286 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
1,640 |
1,497 |
$47K |
| D0274 |
Bitewings - four radiographic images |
941 |
917 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
385 |
184 |
$32K |
| D1110 |
Prophylaxis - adult |
972 |
945 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
472 |
449 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
385 |
374 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,595 |
1,374 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,491 |
821 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
158 |
63 |
$9K |
| D1351 |
Sealant - per tooth |
69 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
26 |
25 |
$2K |