| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,090 |
4,940 |
$206K |
| D0120 |
Periodic oral evaluation - established patient |
4,894 |
4,750 |
$135K |
| D1351 |
Sealant - per tooth |
1,804 |
982 |
$131K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,452 |
3,378 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,104 |
2,053 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
6,739 |
6,467 |
$39K |
| D1110 |
Prophylaxis - adult |
726 |
707 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,686 |
1,666 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,980 |
5,748 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
544 |
349 |
$24K |
| D9110 |
|
396 |
382 |
$22K |
| D0272 |
Bitewings - two radiographic images |
2,137 |
2,037 |
$20K |
| D4341 |
|
79 |
39 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
152 |
98 |
$8K |
| D1206 |
Topical application of fluoride varnish |
208 |
201 |
$5K |
| D0270 |
|
871 |
833 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
171 |
163 |
$4K |
| D4342 |
|
28 |
16 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
210 |
207 |
$4K |
| D0330 |
Panoramic radiographic image |
90 |
90 |
$2K |