| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
61,153 |
59,651 |
$3.27M |
| D1351 |
Sealant - per tooth |
86,014 |
24,359 |
$1.81M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
61,395 |
59,790 |
$1.70M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16,458 |
10,114 |
$1.11M |
| D1206 |
Topical application of fluoride varnish |
65,848 |
64,232 |
$1.04M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16,987 |
10,333 |
$865K |
| D0272 |
Bitewings - two radiographic images |
32,305 |
31,506 |
$612K |
| D0230 |
Intraoral - periapical each additional radiographic image |
75,278 |
38,287 |
$581K |
| D0220 |
Intraoral - periapical first radiographic image |
40,713 |
39,586 |
$449K |
| D0274 |
Bitewings - four radiographic images |
9,304 |
9,024 |
$289K |
| D1110 |
Prophylaxis - adult |
3,582 |
3,504 |
$201K |
| D0120 |
Periodic oral evaluation - established patient |
5,140 |
5,121 |
$163K |
| D7140 |
Extraction, erupted tooth or exposed root |
779 |
558 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
597 |
473 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
435 |
339 |
$32K |
| D1354 |
|
2,258 |
672 |
$19K |
| D2330 |
|
32 |
25 |
$2K |
| D0270 |
|
53 |
53 |
$578.14 |
| D0603 |
|
319 |
314 |
$0.00 |
| D9995 |
|
599 |
473 |
$0.00 |