| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,079 |
9,696 |
$413K |
| D0120 |
Periodic oral evaluation - established patient |
10,774 |
10,389 |
$301K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,427 |
9,080 |
$245K |
| D1351 |
Sealant - per tooth |
2,660 |
1,325 |
$186K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,892 |
1,455 |
$139K |
| D4341 |
|
708 |
399 |
$125K |
| D0220 |
Intraoral - periapical first radiographic image |
13,999 |
13,368 |
$84K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,751 |
1,332 |
$79K |
| D0274 |
Bitewings - four radiographic images |
4,035 |
3,949 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,940 |
2,821 |
$68K |
| D1110 |
Prophylaxis - adult |
1,347 |
1,328 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,029 |
12,461 |
$54K |
| D0272 |
Bitewings - two radiographic images |
3,675 |
3,446 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
1,704 |
1,658 |
$30K |
| D0270 |
|
4,086 |
3,968 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
70 |
54 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
96 |
84 |
$5K |
| D9110 |
|
85 |
85 |
$5K |
| D2331 |
|
32 |
27 |
$2K |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$338.00 |