| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,983 |
4,778 |
$199K |
| D0120 |
Periodic oral evaluation - established patient |
4,463 |
4,287 |
$121K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,193 |
3,043 |
$81K |
| D1351 |
Sealant - per tooth |
1,095 |
587 |
$80K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
525 |
371 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,493 |
1,412 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
3,386 |
3,192 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,122 |
2,945 |
$12K |
| D0272 |
Bitewings - two radiographic images |
781 |
747 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
351 |
334 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
126 |
101 |
$4K |
| D1206 |
Topical application of fluoride varnish |
88 |
86 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
24 |
$2K |
| D0330 |
Panoramic radiographic image |
44 |
42 |
$858.80 |
| D0210 |
Intraoral - complete series of radiographic images |
67 |
61 |
$694.50 |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
12 |
$665.04 |
| D0140 |
Limited oral evaluation - problem focused |
33 |
32 |
$518.40 |