| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,141 |
4,886 |
$217K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,495 |
5,244 |
$151K |
| D0120 |
Periodic oral evaluation - established patient |
5,044 |
4,802 |
$103K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
407 |
297 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
461 |
335 |
$39K |
| D1310 |
|
408 |
396 |
$14K |
| D0272 |
Bitewings - two radiographic images |
536 |
509 |
$13K |
| D1330 |
|
417 |
405 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
338 |
329 |
$12K |
| D1110 |
Prophylaxis - adult |
108 |
108 |
$7K |
| D1351 |
Sealant - per tooth |
177 |
47 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
43 |
43 |
$3K |
| D0330 |
Panoramic radiographic image |
42 |
42 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
27 |
26 |
$405.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$357.00 |