| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,666 |
2,555 |
$109K |
| D0120 |
Periodic oral evaluation - established patient |
3,950 |
3,809 |
$109K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,537 |
1,068 |
$103K |
| D1110 |
Prophylaxis - adult |
2,028 |
1,954 |
$86K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,478 |
2,379 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,375 |
955 |
$61K |
| D0274 |
Bitewings - four radiographic images |
2,745 |
2,641 |
$49K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
521 |
384 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
5,192 |
4,977 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,188 |
1,126 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,706 |
4,417 |
$24K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
45 |
36 |
$15K |
| D1351 |
Sealant - per tooth |
111 |
82 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
53 |
40 |
$3K |
| D0270 |
|
513 |
494 |
$3K |
| D0272 |
Bitewings - two radiographic images |
280 |
266 |
$3K |