| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,517 |
3,323 |
$137K |
| D1351 |
Sealant - per tooth |
1,522 |
844 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
3,511 |
3,300 |
$94K |
| D1206 |
Topical application of fluoride varnish |
3,181 |
3,005 |
$78K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
833 |
604 |
$65K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
376 |
279 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,766 |
1,647 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
4,241 |
3,958 |
$23K |
| D1110 |
Prophylaxis - adult |
457 |
407 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,021 |
3,732 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
719 |
667 |
$14K |
| D9110 |
|
270 |
247 |
$14K |
| D0272 |
Bitewings - two radiographic images |
1,532 |
1,445 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
130 |
117 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
211 |
197 |
$5K |
| D0270 |
|
266 |
246 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
16 |
$978.00 |
| D1999 |
|
392 |
314 |
$0.00 |