| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
14,621 |
14,246 |
$606K |
| D1351 |
Sealant - per tooth |
7,605 |
3,255 |
$443K |
| D0120 |
Periodic oral evaluation - established patient |
14,384 |
14,000 |
$407K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,958 |
12,607 |
$340K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,574 |
2,544 |
$235K |
| D0220 |
Intraoral - periapical first radiographic image |
16,923 |
16,414 |
$104K |
| D0274 |
Bitewings - four radiographic images |
5,527 |
5,384 |
$103K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,870 |
1,452 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,124 |
3,025 |
$71K |
| D1110 |
Prophylaxis - adult |
1,564 |
1,519 |
$68K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,923 |
15,373 |
$67K |
| D0272 |
Bitewings - two radiographic images |
4,427 |
4,300 |
$45K |
| D1206 |
Topical application of fluoride varnish |
1,506 |
1,482 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
1,436 |
1,407 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
289 |
245 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
202 |
162 |
$10K |
| D4341 |
|
60 |
30 |
$10K |