| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
501 |
484 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
468 |
440 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
418 |
406 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
325 |
308 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
299 |
283 |
$8K |
| D1351 |
Sealant - per tooth |
160 |
50 |
$7K |
| D1110 |
Prophylaxis - adult |
237 |
216 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
148 |
103 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
71 |
53 |
$4K |
| D0274 |
Bitewings - four radiographic images |
222 |
211 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
85 |
59 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
573 |
551 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
189 |
179 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
456 |
429 |
$2K |
| D0272 |
Bitewings - two radiographic images |
126 |
120 |
$1K |