| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,256 |
8,097 |
$342K |
| D0120 |
Periodic oral evaluation - established patient |
8,584 |
8,402 |
$242K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,155 |
7,013 |
$189K |
| D1351 |
Sealant - per tooth |
1,925 |
1,424 |
$166K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,087 |
1,770 |
$138K |
| D0274 |
Bitewings - four radiographic images |
4,590 |
4,500 |
$84K |
| D0220 |
Intraoral - periapical first radiographic image |
10,640 |
10,398 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,959 |
1,928 |
$46K |
| D4341 |
|
215 |
146 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,503 |
9,306 |
$40K |
| D1110 |
Prophylaxis - adult |
850 |
842 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
840 |
745 |
$35K |
| D0272 |
Bitewings - two radiographic images |
2,444 |
2,388 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
1,000 |
976 |
$18K |
| D1206 |
Topical application of fluoride varnish |
81 |
81 |
$2K |
| D0270 |
|
14 |
14 |
$72.80 |
| D1999 |
|
23 |
23 |
$0.00 |