| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,651 |
7,245 |
$312K |
| D0120 |
Periodic oral evaluation - established patient |
7,007 |
6,646 |
$195K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,466 |
7,068 |
$193K |
| D1351 |
Sealant - per tooth |
1,418 |
921 |
$95K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
889 |
688 |
$57K |
| D0274 |
Bitewings - four radiographic images |
2,510 |
2,354 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
4,376 |
4,048 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,149 |
3,837 |
$16K |
| D0272 |
Bitewings - two radiographic images |
999 |
930 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
198 |
166 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
313 |
275 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
55 |
49 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
75 |
74 |
$994.72 |