| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,155 |
1,118 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,076 |
1,027 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
623 |
585 |
$15K |
| D1206 |
Topical application of fluoride varnish |
512 |
512 |
$14K |
| D0274 |
Bitewings - four radiographic images |
423 |
391 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
298 |
272 |
$6K |
| D1110 |
Prophylaxis - adult |
94 |
89 |
$4K |
| D0272 |
Bitewings - two radiographic images |
268 |
251 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
122 |
118 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
35 |
28 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
280 |
246 |
$1K |
| D1351 |
Sealant - per tooth |
24 |
12 |
$756.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14 |
12 |
$722.25 |
| D0230 |
Intraoral - periapical each additional radiographic image |
23 |
16 |
$95.00 |