| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,341 |
3,326 |
$180K |
| D1120 |
Prophylaxis - child |
3,317 |
3,302 |
$122K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,122 |
677 |
$73K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,656 |
3,593 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,018 |
600 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,104 |
4,081 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
4,046 |
4,016 |
$47K |
| D1110 |
Prophylaxis - adult |
374 |
372 |
$29K |
| D9430 |
|
847 |
800 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
453 |
450 |
$25K |
| D0350 |
|
1,654 |
1,499 |
$25K |
| D1351 |
Sealant - per tooth |
621 |
158 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
307 |
305 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
56 |
17 |
$3K |