| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,002 |
968 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,108 |
1,072 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
528 |
322 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
972 |
936 |
$22K |
| D1351 |
Sealant - per tooth |
415 |
209 |
$22K |
| D1110 |
Prophylaxis - adult |
326 |
312 |
$11K |
| D0274 |
Bitewings - four radiographic images |
633 |
602 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
544 |
518 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
131 |
108 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,025 |
957 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
315 |
299 |
$5K |
| D0272 |
Bitewings - two radiographic images |
536 |
518 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
353 |
265 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
40 |
31 |
$2K |