| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,071 |
4,979 |
$211K |
| D0120 |
Periodic oral evaluation - established patient |
6,482 |
6,343 |
$185K |
| D1206 |
Topical application of fluoride varnish |
6,887 |
6,746 |
$168K |
| D1110 |
Prophylaxis - adult |
1,913 |
1,859 |
$109K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
797 |
508 |
$94K |
| D1351 |
Sealant - per tooth |
1,897 |
442 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
336 |
275 |
$31K |
| D0330 |
Panoramic radiographic image |
739 |
721 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
479 |
473 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,082 |
1,048 |
$23K |
| D1330 |
|
3,714 |
3,637 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,113 |
1,096 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
248 |
242 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
303 |
292 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
13 |
$2K |