| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,232 |
8,838 |
$380K |
| D0120 |
Periodic oral evaluation - established patient |
9,336 |
8,944 |
$263K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,233 |
8,855 |
$240K |
| D1351 |
Sealant - per tooth |
3,207 |
1,943 |
$220K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
932 |
775 |
$78K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
727 |
609 |
$78K |
| D0274 |
Bitewings - four radiographic images |
3,147 |
3,014 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
441 |
360 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,346 |
1,288 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,903 |
1,887 |
$12K |
| D9110 |
|
141 |
141 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,544 |
1,542 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
43 |
38 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
41 |
40 |
$664.20 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17 |
17 |
$357.85 |