| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,736 |
7,348 |
$303K |
| D1351 |
Sealant - per tooth |
3,777 |
1,999 |
$239K |
| D0120 |
Periodic oral evaluation - established patient |
7,646 |
7,237 |
$211K |
| D1206 |
Topical application of fluoride varnish |
7,737 |
7,352 |
$192K |
| D0601 |
|
4,009 |
3,805 |
$43K |
| D0602 |
|
2,282 |
2,183 |
$26K |
| D0603 |
|
1,063 |
1,056 |
$11K |
| D1354 |
|
312 |
166 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
155 |
116 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
109 |
78 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
55 |
43 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
24 |
24 |
$505.20 |
| D0220 |
Intraoral - periapical first radiographic image |
87 |
87 |
$476.00 |
| D0274 |
Bitewings - four radiographic images |
14 |
14 |
$236.60 |
| D1999 |
|
598 |
598 |
$0.00 |