| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,634 |
2,413 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
2,846 |
2,629 |
$78K |
| D1351 |
Sealant - per tooth |
659 |
227 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
561 |
416 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,266 |
1,146 |
$33K |
| D0274 |
Bitewings - four radiographic images |
732 |
650 |
$12K |
| D1110 |
Prophylaxis - adult |
208 |
205 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
87 |
87 |
$2K |
| D0272 |
Bitewings - two radiographic images |
161 |
159 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
12 |
$1K |