| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
14,083 |
14,059 |
$196K |
| D0120 |
Periodic oral evaluation - established patient |
15,260 |
15,237 |
$181K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,585 |
4,665 |
$162K |
| D1351 |
Sealant - per tooth |
8,253 |
1,887 |
$97K |
| D1206 |
Topical application of fluoride varnish |
10,072 |
10,047 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,811 |
2,196 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,676 |
4,676 |
$37K |
| D0272 |
Bitewings - two radiographic images |
6,915 |
6,909 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
9,185 |
9,115 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
928 |
798 |
$22K |
| D1110 |
Prophylaxis - adult |
1,408 |
1,408 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,205 |
1,204 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,560 |
8,167 |
$16K |
| D0274 |
Bitewings - four radiographic images |
1,854 |
1,850 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
729 |
727 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
194 |
177 |
$5K |
| D0601 |
|
438 |
436 |
$2K |
| D0603 |
|
340 |
339 |
$2K |
| D2331 |
|
59 |
43 |
$2K |
| D0602 |
|
213 |
213 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
18 |
17 |
$105.00 |