| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,311 |
4,093 |
$175K |
| D0120 |
Periodic oral evaluation - established patient |
4,352 |
4,125 |
$120K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,495 |
1,137 |
$105K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,504 |
3,315 |
$90K |
| D1351 |
Sealant - per tooth |
920 |
558 |
$69K |
| D0274 |
Bitewings - four radiographic images |
2,752 |
2,623 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
6,077 |
5,770 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,528 |
1,473 |
$34K |
| D1110 |
Prophylaxis - adult |
711 |
676 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,548 |
5,268 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
450 |
372 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,446 |
1,363 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
586 |
575 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
126 |
104 |
$9K |
| D4341 |
|
43 |
25 |
$8K |
| D1206 |
Topical application of fluoride varnish |
130 |
130 |
$3K |