| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,851 |
9,509 |
$399K |
| D0120 |
Periodic oral evaluation - established patient |
9,294 |
8,965 |
$259K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,589 |
9,249 |
$246K |
| D1351 |
Sealant - per tooth |
2,518 |
1,710 |
$200K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,711 |
1,469 |
$121K |
| D0274 |
Bitewings - four radiographic images |
4,331 |
4,134 |
$75K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
543 |
474 |
$47K |
| D7140 |
Extraction, erupted tooth or exposed root |
734 |
621 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
2,739 |
2,652 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,602 |
1,543 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
253 |
236 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,363 |
2,286 |
$10K |
| D1354 |
|
14 |
14 |
$697.95 |
| D0330 |
Panoramic radiographic image |
31 |
25 |
$678.00 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$248.56 |