| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,746 |
1,666 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
2,245 |
2,130 |
$60K |
| D1110 |
Prophylaxis - adult |
1,018 |
992 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,833 |
1,755 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,335 |
1,271 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
508 |
355 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,320 |
1,260 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
441 |
303 |
$20K |
| D0330 |
Panoramic radiographic image |
869 |
829 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
217 |
168 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
492 |
462 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
511 |
476 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,348 |
1,268 |
$8K |
| D1351 |
Sealant - per tooth |
48 |
15 |
$3K |
| D1206 |
Topical application of fluoride varnish |
60 |
60 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
41 |
28 |
$235.20 |