| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,396 |
5,943 |
$269K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,106 |
6,595 |
$195K |
| D0120 |
Periodic oral evaluation - established patient |
6,591 |
6,110 |
$135K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
947 |
752 |
$101K |
| D1310 |
|
864 |
672 |
$29K |
| D1110 |
Prophylaxis - adult |
444 |
387 |
$27K |
| D1330 |
|
862 |
666 |
$26K |
| D0272 |
Bitewings - two radiographic images |
893 |
841 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
464 |
425 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
184 |
113 |
$15K |
| D1351 |
Sealant - per tooth |
348 |
82 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
108 |
99 |
$8K |
| D0330 |
Panoramic radiographic image |
130 |
124 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
30 |
26 |
$453.00 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$409.00 |