| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,133 |
9,713 |
$401K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,001 |
3,134 |
$303K |
| D0120 |
Periodic oral evaluation - established patient |
9,679 |
9,285 |
$264K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,422 |
9,989 |
$256K |
| D0274 |
Bitewings - four radiographic images |
6,291 |
5,967 |
$91K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,089 |
973 |
$87K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,440 |
1,158 |
$75K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,935 |
9,798 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
10,638 |
10,101 |
$63K |
| D1351 |
Sealant - per tooth |
759 |
555 |
$43K |
| D0272 |
Bitewings - two radiographic images |
2,884 |
2,809 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
443 |
398 |
$24K |
| D9110 |
|
316 |
307 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
745 |
720 |
$17K |
| D2332 |
|
33 |
27 |
$3K |
| D4342 |
|
20 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$13.10 |