| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,940 |
2,938 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
4,260 |
4,257 |
$87K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,896 |
3,894 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
3,954 |
3,952 |
$39K |
| D1120 |
Prophylaxis - child |
1,026 |
1,025 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,867 |
1,867 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,792 |
1,791 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
2,753 |
2,750 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
154 |
116 |
$13K |
| D1351 |
Sealant - per tooth |
26 |
26 |
$4K |
| D0274 |
Bitewings - four radiographic images |
70 |
70 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$1K |