| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,594 |
7,264 |
$377K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,823 |
1,201 |
$363K |
| D0120 |
Periodic oral evaluation - established patient |
7,452 |
7,084 |
$290K |
| D1206 |
Topical application of fluoride varnish |
8,867 |
8,383 |
$271K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
739 |
491 |
$119K |
| D0272 |
Bitewings - two radiographic images |
3,516 |
3,283 |
$119K |
| D1110 |
Prophylaxis - adult |
1,161 |
1,088 |
$76K |
| D0140 |
Limited oral evaluation - problem focused |
845 |
793 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
601 |
543 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
166 |
63 |
$24K |
| D1351 |
Sealant - per tooth |
582 |
161 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
213 |
196 |
$5K |
| D0330 |
Panoramic radiographic image |
30 |
27 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
71 |
13 |
$1K |
| D0603 |
|
6,586 |
6,323 |
$0.00 |
| D0601 |
|
1,172 |
1,100 |
$0.00 |
| D0602 |
|
483 |
459 |
$0.00 |