| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,197 |
8,136 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
8,193 |
8,126 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,890 |
9,805 |
$54K |
| D1354 |
|
8,529 |
1,793 |
$54K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,753 |
1,089 |
$46K |
| D0272 |
Bitewings - two radiographic images |
6,622 |
6,570 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,332 |
778 |
$29K |
| D1351 |
Sealant - per tooth |
3,229 |
854 |
$25K |
| D1206 |
Topical application of fluoride varnish |
3,375 |
3,263 |
$25K |
| D1110 |
Prophylaxis - adult |
1,714 |
1,704 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,564 |
1,549 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,756 |
1,737 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
555 |
547 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,436 |
1,408 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,070 |
993 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
16 |
$390.84 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
20 |
12 |
$207.30 |
| D0140 |
Limited oral evaluation - problem focused |
50 |
47 |
$197.62 |
| D1999 |
|
55 |
52 |
$144.00 |
| D0270 |
|
28 |
26 |
$28.42 |