| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,304 |
7,970 |
$352K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,693 |
7,391 |
$213K |
| D0120 |
Periodic oral evaluation - established patient |
9,290 |
8,918 |
$197K |
| D1110 |
Prophylaxis - adult |
2,072 |
1,990 |
$126K |
| D1351 |
Sealant - per tooth |
3,359 |
855 |
$111K |
| D1206 |
Topical application of fluoride varnish |
2,070 |
1,982 |
$63K |
| D0272 |
Bitewings - two radiographic images |
2,447 |
2,341 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
533 |
322 |
$57K |
| D0330 |
Panoramic radiographic image |
905 |
883 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,523 |
1,478 |
$53K |
| D7140 |
Extraction, erupted tooth or exposed root |
512 |
296 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
853 |
812 |
$31K |
| D1310 |
|
646 |
430 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
254 |
139 |
$20K |
| D1330 |
|
639 |
425 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
218 |
213 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
46 |
46 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16 |
16 |
$190.00 |