| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,333 |
2,187 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
1,889 |
1,777 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,195 |
1,118 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
310 |
231 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
395 |
349 |
$8K |
| D1351 |
Sealant - per tooth |
126 |
80 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,119 |
1,019 |
$6K |
| D0274 |
Bitewings - four radiographic images |
347 |
326 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
679 |
624 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
26 |
$3K |
| D1110 |
Prophylaxis - adult |
92 |
91 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
97 |
89 |
$2K |
| D1206 |
Topical application of fluoride varnish |
52 |
44 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
13 |
$894.65 |
| D7140 |
Extraction, erupted tooth or exposed root |
15 |
12 |
$743.28 |
| D0272 |
Bitewings - two radiographic images |
36 |
36 |
$341.78 |