| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,407 |
5,325 |
$222K |
| D0120 |
Periodic oral evaluation - established patient |
6,968 |
6,832 |
$194K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,259 |
5,177 |
$137K |
| D1110 |
Prophylaxis - adult |
1,526 |
1,494 |
$66K |
| D0274 |
Bitewings - four radiographic images |
1,996 |
1,951 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
981 |
957 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
257 |
229 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
134 |
86 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,223 |
1,208 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
224 |
220 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
298 |
291 |
$2K |
| D1351 |
Sealant - per tooth |
15 |
12 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13 |
12 |
$582.40 |