| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,120 |
4,971 |
$211K |
| D0120 |
Periodic oral evaluation - established patient |
6,052 |
5,884 |
$170K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,809 |
4,679 |
$126K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
361 |
268 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,321 |
1,284 |
$25K |
| D4341 |
|
104 |
46 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
998 |
955 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
2,435 |
2,338 |
$15K |
| D1110 |
Prophylaxis - adult |
310 |
308 |
$14K |
| D1351 |
Sealant - per tooth |
152 |
111 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,270 |
2,188 |
$9K |
| D0330 |
Panoramic radiographic image |
217 |
210 |
$5K |
| D0272 |
Bitewings - two radiographic images |
243 |
235 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
25 |
$1K |
| D9110 |
|
15 |
15 |
$825.00 |