| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,686 |
10,351 |
$465K |
| D0120 |
Periodic oral evaluation - established patient |
10,162 |
9,861 |
$337K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,711 |
10,365 |
$293K |
| D0330 |
Panoramic radiographic image |
1,339 |
1,295 |
$108K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
802 |
417 |
$79K |
| D0274 |
Bitewings - four radiographic images |
1,661 |
1,616 |
$76K |
| D0272 |
Bitewings - two radiographic images |
1,319 |
1,289 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
312 |
172 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
312 |
117 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
170 |
66 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
130 |
123 |
$8K |
| D2394 |
|
41 |
23 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
81 |
76 |
$4K |
| D2940 |
|
63 |
27 |
$3K |
| D1351 |
Sealant - per tooth |
58 |
16 |
$2K |
| D1999 |
|
48 |
32 |
$0.00 |
| D0350 |
|
78 |
67 |
$0.00 |