| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,505 |
2,358 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
2,717 |
2,553 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,430 |
2,285 |
$62K |
| D1351 |
Sealant - per tooth |
952 |
424 |
$57K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
691 |
444 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
955 |
891 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
3,085 |
2,879 |
$17K |
| D0274 |
Bitewings - four radiographic images |
1,027 |
960 |
$16K |
| D1110 |
Prophylaxis - adult |
466 |
435 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,981 |
2,636 |
$15K |
| D4341 |
|
79 |
39 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
334 |
227 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
329 |
298 |
$9K |
| D0272 |
Bitewings - two radiographic images |
750 |
702 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
368 |
341 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
18 |
16 |
$1K |