| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,895 |
5,643 |
$239K |
| D0120 |
Periodic oral evaluation - established patient |
7,191 |
6,759 |
$195K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,106 |
4,887 |
$132K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,682 |
1,411 |
$118K |
| D1351 |
Sealant - per tooth |
1,125 |
795 |
$92K |
| D0274 |
Bitewings - four radiographic images |
4,614 |
4,288 |
$77K |
| D1110 |
Prophylaxis - adult |
1,635 |
1,459 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
9,689 |
9,073 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,966 |
1,870 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
870 |
762 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,915 |
8,358 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
1,630 |
1,504 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,826 |
1,738 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
190 |
167 |
$14K |
| D4341 |
|
73 |
56 |
$12K |
| D9110 |
|
29 |
26 |
$2K |