| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,168 |
11,997 |
$537K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,658 |
1,937 |
$393K |
| D0120 |
Periodic oral evaluation - established patient |
10,658 |
10,520 |
$358K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,516 |
10,371 |
$291K |
| D0272 |
Bitewings - two radiographic images |
5,212 |
5,154 |
$160K |
| D1351 |
Sealant - per tooth |
4,196 |
1,289 |
$159K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,168 |
622 |
$125K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,530 |
1,509 |
$95K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
901 |
573 |
$78K |
| D0330 |
Panoramic radiographic image |
946 |
936 |
$77K |
| D1206 |
Topical application of fluoride varnish |
1,686 |
1,655 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
382 |
369 |
$17K |
| D0240 |
|
606 |
601 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
80 |
65 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
527 |
487 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
21 |
12 |
$4K |
| D2332 |
|
19 |
13 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
110 |
108 |
$2K |