| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
998 |
952 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,093 |
1,046 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
971 |
924 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
250 |
188 |
$15K |
| D1351 |
Sealant - per tooth |
178 |
94 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
462 |
444 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
215 |
132 |
$9K |
| D1110 |
Prophylaxis - adult |
308 |
290 |
$8K |
| D0274 |
Bitewings - four radiographic images |
516 |
498 |
$8K |
| D4341 |
|
29 |
14 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
863 |
817 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
270 |
255 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
231 |
215 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
695 |
630 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
80 |
66 |
$3K |
| D0330 |
Panoramic radiographic image |
138 |
132 |
$2K |
| D0272 |
Bitewings - two radiographic images |
126 |
119 |
$1K |
| D0270 |
|
28 |
27 |
$141.90 |