| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
19,542 |
19,470 |
$674K |
| D0120 |
Periodic oral evaluation - established patient |
28,897 |
28,789 |
$633K |
| D1351 |
Sealant - per tooth |
7,925 |
3,778 |
$454K |
| D1110 |
Prophylaxis - adult |
10,695 |
10,655 |
$427K |
| D1208 |
Topical application of fluoride, excluding varnish |
26,103 |
26,003 |
$319K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,126 |
22,085 |
$292K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,214 |
2,743 |
$266K |
| D0220 |
Intraoral - periapical first radiographic image |
22,350 |
22,307 |
$214K |
| D0272 |
Bitewings - two radiographic images |
13,913 |
13,887 |
$171K |
| D0274 |
Bitewings - four radiographic images |
3,605 |
3,605 |
$86K |
| D0210 |
Intraoral - complete series of radiographic images |
4,303 |
4,294 |
$74K |
| D2394 |
|
672 |
594 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
883 |
719 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,384 |
1,384 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
452 |
392 |
$35K |
| D1206 |
Topical application of fluoride varnish |
702 |
702 |
$20K |
| D9110 |
|
704 |
700 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
219 |
194 |
$9K |
| D9999 |
Unspecified adjunctive procedure, by report |
26 |
26 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
19 |
12 |
$2K |
| D0601 |
|
771 |
769 |
$466.00 |