| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,286 |
5,977 |
$257K |
| D0120 |
Periodic oral evaluation - established patient |
6,916 |
6,591 |
$192K |
| D1351 |
Sealant - per tooth |
1,853 |
1,100 |
$127K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,484 |
3,273 |
$90K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
831 |
691 |
$54K |
| D0330 |
Panoramic radiographic image |
1,837 |
1,700 |
$43K |
| D0274 |
Bitewings - four radiographic images |
2,322 |
2,234 |
$41K |
| D1110 |
Prophylaxis - adult |
927 |
875 |
$37K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
484 |
400 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
1,471 |
1,393 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
2,921 |
2,738 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
791 |
732 |
$17K |
| D0272 |
Bitewings - two radiographic images |
776 |
714 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,176 |
1,150 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
91 |
80 |
$4K |
| D1206 |
Topical application of fluoride varnish |
110 |
104 |
$3K |
| D2394 |
|
33 |
31 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
42 |
38 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
66 |
58 |
$1K |