| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
8,153 |
8,135 |
$346K |
| D0120 |
Periodic oral evaluation - established patient |
12,010 |
11,985 |
$278K |
| D1120 |
Prophylaxis - child |
3,972 |
3,964 |
$156K |
| D0272 |
Bitewings - two radiographic images |
10,438 |
10,435 |
$139K |
| D0220 |
Intraoral - periapical first radiographic image |
12,817 |
12,739 |
$109K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,121 |
7,105 |
$93K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,355 |
843 |
$75K |
| D1351 |
Sealant - per tooth |
1,247 |
502 |
$67K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,198 |
12,182 |
$66K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
854 |
542 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
674 |
655 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
85 |
71 |
$4K |
| D1999 |
|
170 |
170 |
$0.00 |