| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,542 |
4,248 |
$191K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,292 |
1,655 |
$181K |
| D1206 |
Topical application of fluoride varnish |
5,212 |
4,906 |
$180K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,280 |
1,322 |
$171K |
| D0120 |
Periodic oral evaluation - established patient |
4,627 |
4,345 |
$95K |
| D0274 |
Bitewings - four radiographic images |
2,215 |
2,105 |
$53K |
| D1110 |
Prophylaxis - adult |
1,147 |
1,114 |
$46K |
| D1310 |
|
1,327 |
1,165 |
$29K |
| D0330 |
Panoramic radiographic image |
551 |
543 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
1,005 |
911 |
$25K |
| D1330 |
|
1,320 |
1,164 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
580 |
542 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,210 |
1,045 |
$15K |
| D9920 |
|
512 |
415 |
$13K |
| D1351 |
Sealant - per tooth |
574 |
199 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
354 |
328 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
170 |
111 |
$8K |
| D0272 |
Bitewings - two radiographic images |
333 |
282 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
56 |
26 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
450 |
367 |
$4K |