| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,387 |
4,265 |
$169K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,014 |
3,911 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
3,535 |
3,433 |
$92K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,116 |
848 |
$61K |
| D1351 |
Sealant - per tooth |
828 |
293 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,127 |
1,092 |
$23K |
| D0274 |
Bitewings - four radiographic images |
1,377 |
1,333 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
585 |
468 |
$20K |
| D0272 |
Bitewings - two radiographic images |
797 |
778 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
86 |
71 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
76 |
69 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
186 |
179 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
567 |
538 |
$3K |