| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,803 |
8,555 |
$360K |
| D0120 |
Periodic oral evaluation - established patient |
9,879 |
9,552 |
$273K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,586 |
8,356 |
$223K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,556 |
1,876 |
$166K |
| D1351 |
Sealant - per tooth |
2,379 |
1,320 |
$162K |
| D1110 |
Prophylaxis - adult |
2,620 |
2,507 |
$110K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,701 |
1,141 |
$101K |
| D0274 |
Bitewings - four radiographic images |
4,902 |
4,698 |
$87K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,990 |
1,480 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,247 |
3,130 |
$72K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
685 |
534 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
3,181 |
3,015 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
6,300 |
5,959 |
$37K |
| D0272 |
Bitewings - two radiographic images |
2,867 |
2,785 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,491 |
2,231 |
$20K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
20 |
15 |
$5K |
| D1999 |
|
2,572 |
2,175 |
$0.00 |