| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,523 |
11,949 |
$508K |
| D0120 |
Periodic oral evaluation - established patient |
13,656 |
13,003 |
$376K |
| D1351 |
Sealant - per tooth |
5,662 |
3,272 |
$370K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,248 |
11,694 |
$315K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,977 |
2,698 |
$273K |
| D1110 |
Prophylaxis - adult |
3,552 |
3,428 |
$147K |
| D0274 |
Bitewings - four radiographic images |
6,671 |
6,412 |
$118K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,092 |
1,499 |
$111K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,427 |
4,200 |
$98K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,782 |
1,331 |
$82K |
| D0140 |
Limited oral evaluation - problem focused |
4,058 |
3,780 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
7,402 |
6,961 |
$44K |
| D0272 |
Bitewings - two radiographic images |
4,317 |
4,064 |
$42K |
| D4341 |
|
147 |
87 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,738 |
2,506 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
309 |
251 |
$22K |
| D2330 |
|
75 |
38 |
$5K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
14 |
12 |
$4K |
| D1999 |
|
2,935 |
2,580 |
$20.00 |