| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,409 |
2,299 |
$95K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,378 |
2,266 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
1,766 |
1,694 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
868 |
549 |
$44K |
| D1351 |
Sealant - per tooth |
874 |
442 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,010 |
966 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
573 |
368 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,427 |
2,211 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
2,687 |
2,532 |
$15K |
| D0274 |
Bitewings - four radiographic images |
767 |
730 |
$13K |
| D1110 |
Prophylaxis - adult |
291 |
276 |
$7K |
| D0272 |
Bitewings - two radiographic images |
440 |
432 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
78 |
59 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
161 |
151 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
36 |
29 |
$2K |
| D9110 |
|
41 |
41 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
74 |
54 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$363.20 |