| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
12,764 |
12,747 |
$285K |
| D1110 |
Prophylaxis - adult |
5,960 |
5,956 |
$261K |
| D1120 |
Prophylaxis - child |
6,812 |
6,798 |
$226K |
| D0274 |
Bitewings - four radiographic images |
10,122 |
10,118 |
$225K |
| D1351 |
Sealant - per tooth |
3,812 |
1,733 |
$196K |
| D0220 |
Intraoral - periapical first radiographic image |
13,263 |
13,013 |
$139K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,535 |
1,154 |
$111K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,232 |
8,220 |
$93K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,564 |
11,558 |
$65K |
| D7140 |
Extraction, erupted tooth or exposed root |
743 |
638 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
1,883 |
1,857 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
84 |
69 |
$7K |