| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,101 |
2,078 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
2,692 |
2,667 |
$75K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,024 |
1,996 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
753 |
695 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,659 |
1,644 |
$31K |
| D1110 |
Prophylaxis - adult |
542 |
537 |
$25K |
| D0330 |
Panoramic radiographic image |
953 |
941 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
533 |
488 |
$21K |
| D1351 |
Sealant - per tooth |
214 |
182 |
$21K |
| D4341 |
|
136 |
94 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
852 |
835 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
262 |
246 |
$20K |
| D9110 |
|
341 |
328 |
$19K |
| D4342 |
|
129 |
103 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,169 |
1,137 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
826 |
786 |
$7K |
| D0272 |
Bitewings - two radiographic images |
538 |
525 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15 |
13 |
$3K |