| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
655 |
638 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
759 |
737 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
613 |
597 |
$13K |
| D1110 |
Prophylaxis - adult |
282 |
267 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
137 |
116 |
$8K |
| D1351 |
Sealant - per tooth |
104 |
83 |
$7K |
| D0274 |
Bitewings - four radiographic images |
412 |
389 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
120 |
105 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
240 |
225 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
65 |
53 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
494 |
461 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
408 |
291 |
$2K |
| D0272 |
Bitewings - two radiographic images |
208 |
202 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
124 |
118 |
$2K |
| D1206 |
Topical application of fluoride varnish |
31 |
31 |
$108.30 |