| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,524 |
2,460 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
3,413 |
3,317 |
$87K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,544 |
1,500 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
436 |
365 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,511 |
1,477 |
$26K |
| D1110 |
Prophylaxis - adult |
881 |
843 |
$26K |
| D1351 |
Sealant - per tooth |
355 |
227 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
972 |
859 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
405 |
342 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,324 |
1,234 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
188 |
159 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
217 |
207 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
57 |
50 |
$4K |
| D0272 |
Bitewings - two radiographic images |
262 |
253 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
13 |
$731.98 |
| D0230 |
Intraoral - periapical each additional radiographic image |
73 |
70 |
$415.32 |