| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
713 |
673 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
845 |
781 |
$23K |
| D1351 |
Sealant - per tooth |
328 |
127 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
701 |
660 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
194 |
164 |
$11K |
| D0274 |
Bitewings - four radiographic images |
664 |
619 |
$11K |
| D1110 |
Prophylaxis - adult |
221 |
204 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
325 |
300 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,090 |
639 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
881 |
775 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
83 |
79 |
$3K |
| D9110 |
|
56 |
53 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
37 |
26 |
$3K |
| D0330 |
Panoramic radiographic image |
106 |
106 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
26 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
127 |
115 |
$2K |
| D0272 |
Bitewings - two radiographic images |
135 |
134 |
$1K |