| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,522 |
2,395 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
2,726 |
2,580 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,518 |
2,391 |
$62K |
| D1351 |
Sealant - per tooth |
855 |
305 |
$37K |
| D0274 |
Bitewings - four radiographic images |
972 |
911 |
$16K |
| D1110 |
Prophylaxis - adult |
377 |
348 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
329 |
314 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
100 |
58 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
99 |
68 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
269 |
249 |
$4K |
| D0272 |
Bitewings - two radiographic images |
407 |
379 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
81 |
42 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
573 |
536 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
306 |
271 |
$2K |