| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,631 |
2,361 |
$73K |
| D1206 |
Topical application of fluoride varnish |
2,433 |
2,181 |
$56K |
| D1351 |
Sealant - per tooth |
2,083 |
293 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
1,580 |
1,298 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
462 |
288 |
$48K |
| D0330 |
Panoramic radiographic image |
1,163 |
1,020 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,128 |
991 |
$36K |
| D0274 |
Bitewings - four radiographic images |
970 |
913 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
813 |
784 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
305 |
221 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
248 |
147 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,118 |
980 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
156 |
113 |
$7K |
| D0272 |
Bitewings - two radiographic images |
284 |
221 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
369 |
137 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
46 |
46 |
$889.64 |