| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,284 |
1,883 |
$81K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
639 |
279 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
2,867 |
2,371 |
$64K |
| D1110 |
Prophylaxis - adult |
1,288 |
1,128 |
$63K |
| D1206 |
Topical application of fluoride varnish |
2,198 |
1,910 |
$40K |
| D0274 |
Bitewings - four radiographic images |
716 |
636 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
320 |
117 |
$20K |
| D0330 |
Panoramic radiographic image |
334 |
303 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
201 |
99 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
815 |
568 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
318 |
278 |
$11K |
| D1320 |
|
317 |
269 |
$8K |
| D1351 |
Sealant - per tooth |
176 |
29 |
$6K |
| D0272 |
Bitewings - two radiographic images |
171 |
113 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
105 |
60 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
123 |
97 |
$2K |