| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
17,327 |
17,179 |
$500K |
| D1208 |
Topical application of fluoride, excluding varnish |
26,229 |
26,017 |
$467K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16,753 |
16,538 |
$413K |
| D1110 |
Prophylaxis - adult |
8,962 |
8,888 |
$357K |
| D9920 |
|
5,423 |
5,315 |
$287K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,614 |
2,722 |
$274K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,576 |
2,610 |
$235K |
| D0120 |
Periodic oral evaluation - established patient |
9,627 |
9,622 |
$189K |
| D0330 |
Panoramic radiographic image |
2,959 |
2,928 |
$139K |
| D0274 |
Bitewings - four radiographic images |
5,701 |
5,654 |
$134K |
| D9630 |
|
5,760 |
5,673 |
$87K |
| D0272 |
Bitewings - two radiographic images |
4,836 |
4,785 |
$86K |
| D1351 |
Sealant - per tooth |
2,759 |
707 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
336 |
218 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
742 |
739 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
321 |
315 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
86 |
77 |
$8K |
| D9994 |
|
87 |
82 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
374 |
374 |
$4K |
| D3120 |
|
36 |
21 |
$662.76 |
| D1354 |
|
39 |
12 |
$468.00 |