| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,410 |
3,353 |
$79K |
| D1120 |
Prophylaxis - child |
3,136 |
3,073 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,739 |
4,650 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
919 |
446 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,486 |
1,450 |
$45K |
| D1351 |
Sealant - per tooth |
2,549 |
728 |
$45K |
| D1110 |
Prophylaxis - adult |
1,617 |
1,592 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
1,093 |
1,080 |
$40K |
| D0272 |
Bitewings - two radiographic images |
2,505 |
2,458 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
431 |
292 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
950 |
924 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
729 |
673 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
75 |
54 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
45 |
45 |
$1K |