| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,468 |
9,329 |
$408K |
| D0120 |
Periodic oral evaluation - established patient |
13,096 |
12,891 |
$381K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,034 |
1,872 |
$364K |
| D1206 |
Topical application of fluoride varnish |
13,778 |
13,570 |
$338K |
| D1110 |
Prophylaxis - adult |
4,908 |
4,827 |
$289K |
| D1351 |
Sealant - per tooth |
5,407 |
935 |
$178K |
| D0330 |
Panoramic radiographic image |
1,982 |
1,936 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
791 |
536 |
$71K |
| D0140 |
Limited oral evaluation - problem focused |
1,480 |
1,409 |
$64K |
| D0274 |
Bitewings - four radiographic images |
2,761 |
2,701 |
$60K |
| D0272 |
Bitewings - two radiographic images |
3,615 |
3,542 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
881 |
862 |
$45K |
| D1330 |
|
7,246 |
7,109 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
93 |
65 |
$11K |
| D2394 |
|
47 |
28 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
531 |
515 |
$5K |