| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,886 |
7,508 |
$312K |
| D0120 |
Periodic oral evaluation - established patient |
8,522 |
8,102 |
$231K |
| D1206 |
Topical application of fluoride varnish |
7,775 |
7,404 |
$195K |
| D1351 |
Sealant - per tooth |
2,069 |
1,245 |
$160K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,584 |
1,369 |
$98K |
| D0274 |
Bitewings - four radiographic images |
4,637 |
4,426 |
$75K |
| D1110 |
Prophylaxis - adult |
1,409 |
1,349 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
9,871 |
9,296 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,380 |
8,802 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,690 |
1,624 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
833 |
697 |
$32K |
| D0272 |
Bitewings - two radiographic images |
2,688 |
2,510 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
99 |
95 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
109 |
91 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
149 |
134 |
$2K |
| D0270 |
|
108 |
99 |
$565.60 |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
13 |
$338.00 |
| D1999 |
|
972 |
743 |
$0.00 |