| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,445 |
4,422 |
$151K |
| D0120 |
Periodic oral evaluation - established patient |
5,869 |
5,836 |
$144K |
| D1110 |
Prophylaxis - adult |
2,842 |
2,832 |
$124K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,987 |
4,964 |
$103K |
| D1351 |
Sealant - per tooth |
2,529 |
947 |
$75K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
966 |
520 |
$72K |
| D0210 |
Intraoral - complete series of radiographic images |
1,078 |
1,077 |
$65K |
| D1206 |
Topical application of fluoride varnish |
2,181 |
2,177 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,438 |
1,427 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,035 |
1,034 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
324 |
182 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,010 |
1,003 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
553 |
552 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
12 |
$1K |