| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,559 |
6,323 |
$261K |
| D0120 |
Periodic oral evaluation - established patient |
8,250 |
7,955 |
$227K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,021 |
4,875 |
$131K |
| D0274 |
Bitewings - four radiographic images |
3,176 |
3,075 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,075 |
829 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
4,598 |
4,421 |
$28K |
| D1110 |
Prophylaxis - adult |
555 |
547 |
$25K |
| D1351 |
Sealant - per tooth |
393 |
209 |
$24K |
| D1206 |
Topical application of fluoride varnish |
996 |
936 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,130 |
3,971 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
283 |
222 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
423 |
389 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
92 |
66 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
147 |
146 |
$3K |
| D0272 |
Bitewings - two radiographic images |
217 |
202 |
$2K |
| D9310 |
|
78 |
68 |
$1K |
| D0603 |
|
979 |
939 |
$0.00 |
| D0601 |
|
14 |
13 |
$0.00 |