| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,495 |
12,692 |
$655K |
| D1206 |
Topical application of fluoride varnish |
10,953 |
10,295 |
$436K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,179 |
1,737 |
$191K |
| D0120 |
Periodic oral evaluation - established patient |
7,332 |
6,813 |
$177K |
| D1351 |
Sealant - per tooth |
5,681 |
1,687 |
$176K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,286 |
1,659 |
$143K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,366 |
3,108 |
$104K |
| D9920 |
|
1,592 |
1,436 |
$98K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,235 |
624 |
$78K |
| D0272 |
Bitewings - two radiographic images |
3,117 |
2,929 |
$73K |
| D0140 |
Limited oral evaluation - problem focused |
1,542 |
1,407 |
$43K |
| D1110 |
Prophylaxis - adult |
882 |
775 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,034 |
944 |
$37K |
| D0274 |
Bitewings - four radiographic images |
943 |
839 |
$26K |
| D2940 |
|
357 |
235 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
998 |
919 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
448 |
430 |
$14K |
| D0330 |
Panoramic radiographic image |
127 |
117 |
$8K |
| D0240 |
|
165 |
157 |
$7K |
| D1354 |
|
144 |
75 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
23 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$169.86 |