| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,784 |
2,629 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
2,938 |
2,773 |
$78K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,390 |
2,245 |
$60K |
| D1351 |
Sealant - per tooth |
745 |
421 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,684 |
1,587 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
481 |
323 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,208 |
1,145 |
$25K |
| D4341 |
|
117 |
57 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
2,766 |
2,580 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
329 |
249 |
$15K |
| D1110 |
Prophylaxis - adult |
442 |
400 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,375 |
2,183 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
123 |
90 |
$8K |
| D0272 |
Bitewings - two radiographic images |
505 |
472 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
280 |
270 |
$4K |
| D1206 |
Topical application of fluoride varnish |
162 |
160 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
169 |
165 |
$3K |