| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,284 |
3,095 |
$153K |
| D0120 |
Periodic oral evaluation - established patient |
5,128 |
4,852 |
$111K |
| D1120 |
Prophylaxis - child |
2,646 |
2,483 |
$76K |
| D1351 |
Sealant - per tooth |
3,168 |
555 |
$75K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,022 |
690 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,983 |
1,852 |
$64K |
| D0274 |
Bitewings - four radiographic images |
1,997 |
1,892 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,786 |
2,596 |
$49K |
| D0330 |
Panoramic radiographic image |
1,310 |
1,205 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
1,078 |
952 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
707 |
544 |
$39K |
| D0272 |
Bitewings - two radiographic images |
1,543 |
1,433 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,000 |
964 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
739 |
695 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
520 |
487 |
$6K |