| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,050 |
11,748 |
$498K |
| D0120 |
Periodic oral evaluation - established patient |
12,797 |
12,435 |
$360K |
| D1351 |
Sealant - per tooth |
5,671 |
2,444 |
$315K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,566 |
3,364 |
$300K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,426 |
10,154 |
$274K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,548 |
1,287 |
$127K |
| D0274 |
Bitewings - four radiographic images |
5,858 |
5,650 |
$103K |
| D0220 |
Intraoral - periapical first radiographic image |
15,126 |
14,641 |
$92K |
| D1110 |
Prophylaxis - adult |
1,643 |
1,564 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,915 |
14,275 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,433 |
1,142 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,220 |
2,140 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
2,665 |
2,595 |
$48K |
| D0272 |
Bitewings - two radiographic images |
3,602 |
3,514 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
548 |
427 |
$33K |
| D1206 |
Topical application of fluoride varnish |
970 |
950 |
$26K |
| D4341 |
|
77 |
41 |
$13K |
| D8999 |
|
122 |
121 |
$6K |
| D9110 |
|
81 |
79 |
$4K |
| D8660 |
|
16 |
16 |
$2K |
| D1999 |
|
16 |
13 |
$0.00 |