| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,616 |
3,449 |
$144K |
| D1351 |
Sealant - per tooth |
2,318 |
1,031 |
$115K |
| D0120 |
Periodic oral evaluation - established patient |
3,718 |
3,565 |
$100K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,616 |
3,448 |
$91K |
| D1110 |
Prophylaxis - adult |
915 |
875 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,940 |
1,857 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,250 |
1,188 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
479 |
328 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
270 |
209 |
$14K |
| D0272 |
Bitewings - two radiographic images |
1,020 |
971 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,693 |
1,623 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,252 |
1,111 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
390 |
371 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
51 |
42 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
121 |
115 |
$1K |