| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,376 |
7,187 |
$304K |
| D0120 |
Periodic oral evaluation - established patient |
7,617 |
7,379 |
$213K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,336 |
6,198 |
$166K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,616 |
1,287 |
$115K |
| D1351 |
Sealant - per tooth |
893 |
618 |
$77K |
| D0274 |
Bitewings - four radiographic images |
4,072 |
3,943 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
9,215 |
8,909 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,492 |
8,213 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,338 |
1,297 |
$31K |
| D0272 |
Bitewings - two radiographic images |
2,395 |
2,316 |
$24K |
| D1110 |
Prophylaxis - adult |
527 |
506 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
468 |
371 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
695 |
679 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
72 |
54 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$870.75 |
| D0270 |
|
32 |
32 |
$179.20 |