| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,962 |
2,926 |
$85K |
| D1110 |
Prophylaxis - adult |
1,410 |
1,388 |
$83K |
| D1120 |
Prophylaxis - child |
1,939 |
1,909 |
$82K |
| D1206 |
Topical application of fluoride varnish |
3,361 |
3,314 |
$82K |
| D1351 |
Sealant - per tooth |
1,608 |
360 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
193 |
147 |
$22K |
| D0274 |
Bitewings - four radiographic images |
608 |
597 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
214 |
210 |
$11K |
| D0272 |
Bitewings - two radiographic images |
554 |
547 |
$8K |
| D1330 |
|
801 |
791 |
$5K |
| D0330 |
Panoramic radiographic image |
53 |
53 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
42 |
41 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
121 |
115 |
$1K |