| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,250 |
2,164 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
2,578 |
2,465 |
$72K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,104 |
2,023 |
$55K |
| D1351 |
Sealant - per tooth |
526 |
381 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
564 |
446 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,178 |
1,126 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
369 |
307 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
2,809 |
2,684 |
$17K |
| D4341 |
|
99 |
55 |
$17K |
| D1110 |
Prophylaxis - adult |
345 |
329 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
680 |
662 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,400 |
2,296 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
508 |
480 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
243 |
229 |
$6K |
| D0270 |
|
517 |
516 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
28 |
26 |
$3K |
| D0272 |
Bitewings - two radiographic images |
137 |
137 |
$1K |