| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,342 |
4,137 |
$171K |
| D0120 |
Periodic oral evaluation - established patient |
4,688 |
4,456 |
$126K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,585 |
1,204 |
$124K |
| D1206 |
Topical application of fluoride varnish |
3,704 |
3,525 |
$92K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
480 |
373 |
$39K |
| D0274 |
Bitewings - four radiographic images |
2,294 |
2,193 |
$37K |
| D1110 |
Prophylaxis - adult |
789 |
750 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
5,573 |
5,254 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,073 |
4,735 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
899 |
863 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,388 |
1,317 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
234 |
191 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
518 |
488 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
62 |
49 |
$4K |
| D1351 |
Sealant - per tooth |
39 |
27 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
57 |
55 |
$1K |
| D0270 |
|
183 |
166 |
$968.80 |
| D1999 |
|
514 |
352 |
$0.00 |