| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,003 |
923 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,063 |
962 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
404 |
217 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
940 |
873 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
710 |
642 |
$14K |
| D1351 |
Sealant - per tooth |
186 |
105 |
$14K |
| D1110 |
Prophylaxis - adult |
373 |
318 |
$14K |
| D0330 |
Panoramic radiographic image |
832 |
726 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
214 |
153 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,561 |
1,404 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
654 |
584 |
$7K |
| D0274 |
Bitewings - four radiographic images |
585 |
524 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,354 |
1,155 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
420 |
364 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
115 |
63 |
$4K |
| D0272 |
Bitewings - two radiographic images |
290 |
276 |
$2K |