| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,268 |
2,203 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,827 |
1,781 |
$41K |
| D1206 |
Topical application of fluoride varnish |
2,579 |
2,514 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
880 |
853 |
$31K |
| D1351 |
Sealant - per tooth |
1,639 |
517 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
395 |
305 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,431 |
1,377 |
$19K |
| D0274 |
Bitewings - four radiographic images |
780 |
770 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,137 |
852 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
896 |
875 |
$8K |
| D1110 |
Prophylaxis - adult |
286 |
284 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
18 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
100 |
90 |
$1K |