| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,581 |
1,513 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
1,862 |
1,798 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,571 |
1,505 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
562 |
356 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,154 |
1,097 |
$18K |
| D1110 |
Prophylaxis - adult |
475 |
457 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
287 |
196 |
$12K |
| D1351 |
Sealant - per tooth |
256 |
116 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
578 |
550 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,751 |
1,660 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
299 |
188 |
$9K |
| D4341 |
|
42 |
26 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,606 |
1,397 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
342 |
315 |
$5K |
| D0272 |
Bitewings - two radiographic images |
266 |
253 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
159 |
147 |
$1K |