| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
14,198 |
13,998 |
$586K |
| D0120 |
Periodic oral evaluation - established patient |
13,945 |
13,753 |
$393K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,484 |
12,310 |
$327K |
| D1351 |
Sealant - per tooth |
3,546 |
3,067 |
$233K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,233 |
2,902 |
$194K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,967 |
1,766 |
$138K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,088 |
992 |
$51K |
| D0274 |
Bitewings - four radiographic images |
2,751 |
2,704 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,257 |
1,174 |
$46K |
| D0272 |
Bitewings - two radiographic images |
2,869 |
2,829 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
1,214 |
1,160 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
2,071 |
2,030 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
166 |
164 |
$3K |
| D0330 |
Panoramic radiographic image |
110 |
110 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
247 |
246 |
$1K |