| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,923 |
11,531 |
$453K |
| D0120 |
Periodic oral evaluation - established patient |
11,317 |
10,960 |
$293K |
| D1206 |
Topical application of fluoride varnish |
11,846 |
11,472 |
$281K |
| D1351 |
Sealant - per tooth |
5,052 |
2,479 |
$239K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
938 |
878 |
$22K |
| D0999 |
Unspecified diagnostic procedure, by report |
335 |
162 |
$22K |
| D0274 |
Bitewings - four radiographic images |
541 |
496 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
116 |
86 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,258 |
1,161 |
$7K |
| D0601 |
|
4,565 |
4,518 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
104 |
74 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
954 |
890 |
$4K |
| D0602 |
|
3,408 |
3,371 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
104 |
95 |
$2K |
| D0272 |
Bitewings - two radiographic images |
194 |
187 |
$2K |
| D0603 |
|
940 |
930 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
15 |
13 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
30 |
26 |
$699.00 |
| D1330 |
|
149 |
84 |
$0.00 |