| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,046 |
8,746 |
$370K |
| D0120 |
Periodic oral evaluation - established patient |
9,311 |
8,972 |
$259K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,031 |
7,752 |
$209K |
| D1351 |
Sealant - per tooth |
2,232 |
1,483 |
$179K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,252 |
1,859 |
$140K |
| D0274 |
Bitewings - four radiographic images |
4,682 |
4,483 |
$83K |
| D0220 |
Intraoral - periapical first radiographic image |
11,003 |
10,565 |
$66K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,225 |
1,069 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,402 |
9,993 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,737 |
1,654 |
$38K |
| D1110 |
Prophylaxis - adult |
870 |
827 |
$38K |
| D0272 |
Bitewings - two radiographic images |
2,817 |
2,700 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
387 |
321 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
1,255 |
1,177 |
$22K |
| D4341 |
|
22 |
15 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
15 |
13 |
$963.90 |