| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,186 |
12,026 |
$438K |
| D0120 |
Periodic oral evaluation - established patient |
13,830 |
13,635 |
$388K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,516 |
2,062 |
$347K |
| D1110 |
Prophylaxis - adult |
6,954 |
6,851 |
$344K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,939 |
15,715 |
$324K |
| D0272 |
Bitewings - two radiographic images |
9,464 |
9,290 |
$208K |
| D0220 |
Intraoral - periapical first radiographic image |
12,298 |
12,096 |
$181K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,152 |
3,100 |
$151K |
| D2332 |
|
895 |
430 |
$150K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,393 |
9,976 |
$131K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,720 |
1,036 |
$125K |
| D0330 |
Panoramic radiographic image |
1,738 |
1,720 |
$104K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,034 |
2,006 |
$96K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
409 |
261 |
$61K |
| D1351 |
Sealant - per tooth |
2,126 |
555 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
1,809 |
1,754 |
$26K |
| D2140 |
|
20 |
12 |
$1K |