| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,365 |
4,222 |
$176K |
| D0120 |
Periodic oral evaluation - established patient |
5,059 |
4,850 |
$138K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,352 |
3,241 |
$83K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
689 |
551 |
$39K |
| D0274 |
Bitewings - four radiographic images |
2,265 |
2,187 |
$39K |
| D1110 |
Prophylaxis - adult |
916 |
879 |
$35K |
| D1351 |
Sealant - per tooth |
302 |
133 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
711 |
693 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
249 |
198 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
344 |
334 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
132 |
75 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,171 |
1,074 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
366 |
344 |
$6K |
| D0330 |
Panoramic radiographic image |
70 |
63 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
17 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
13 |
$782.40 |
| D0272 |
Bitewings - two radiographic images |
81 |
79 |
$756.86 |
| D0230 |
Intraoral - periapical each additional radiographic image |
70 |
68 |
$307.43 |