| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,282 |
2,182 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
1,979 |
1,884 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
717 |
478 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,972 |
1,877 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,786 |
1,713 |
$40K |
| D1351 |
Sealant - per tooth |
280 |
160 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
1,434 |
1,363 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
304 |
195 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,145 |
1,092 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
628 |
603 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
200 |
111 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,781 |
1,692 |
$11K |
| D1110 |
Prophylaxis - adult |
249 |
219 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
202 |
126 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
355 |
331 |
$2K |
| D0272 |
Bitewings - two radiographic images |
113 |
108 |
$1K |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$364.00 |