| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
52,063 |
51,891 |
$1.46M |
| D1206 |
Topical application of fluoride varnish |
55,578 |
55,349 |
$960K |
| D1351 |
Sealant - per tooth |
34,095 |
11,483 |
$886K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
25,413 |
25,301 |
$680K |
| D1354 |
|
45,565 |
12,348 |
$631K |
| D0120 |
Periodic oral evaluation - established patient |
30,502 |
30,382 |
$500K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,022 |
3,303 |
$492K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,189 |
3,269 |
$489K |
| D1355 |
|
14,144 |
3,728 |
$429K |
| D0230 |
Intraoral - periapical each additional radiographic image |
33,478 |
21,614 |
$293K |
| D0272 |
Bitewings - two radiographic images |
16,539 |
16,485 |
$286K |
| D0220 |
Intraoral - periapical first radiographic image |
23,359 |
23,215 |
$213K |
| D0274 |
Bitewings - four radiographic images |
7,554 |
7,485 |
$185K |
| D1110 |
Prophylaxis - adult |
3,287 |
3,248 |
$124K |
| D0210 |
Intraoral - complete series of radiographic images |
3,166 |
2,859 |
$44K |
| D2330 |
|
439 |
215 |
$42K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
315 |
185 |
$35K |
| D2394 |
|
20 |
15 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
16 |
$1K |