| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,028 |
7,615 |
$318K |
| D1351 |
Sealant - per tooth |
3,529 |
2,349 |
$289K |
| D0120 |
Periodic oral evaluation - established patient |
9,195 |
8,719 |
$249K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,036 |
7,619 |
$201K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,456 |
1,167 |
$99K |
| D0274 |
Bitewings - four radiographic images |
4,699 |
4,476 |
$84K |
| D1110 |
Prophylaxis - adult |
1,594 |
1,551 |
$69K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,151 |
942 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,248 |
2,138 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
8,330 |
7,891 |
$51K |
| D4341 |
|
260 |
147 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
895 |
738 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,312 |
6,873 |
$40K |
| D0272 |
Bitewings - two radiographic images |
2,290 |
2,159 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
1,122 |
1,060 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
45 |
38 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
272 |
256 |
$4K |
| D1999 |
|
1,562 |
1,380 |
$0.00 |