| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,967 |
1,908 |
$64K |
| D0274 |
Bitewings - four radiographic images |
2,322 |
2,241 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
1,868 |
1,824 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,646 |
1,598 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,026 |
991 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
3,433 |
3,304 |
$26K |
| D1120 |
Prophylaxis - child |
1,067 |
1,049 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,097 |
2,743 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
416 |
269 |
$23K |
| D1351 |
Sealant - per tooth |
673 |
102 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
315 |
185 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
371 |
371 |
$15K |
| D1206 |
Topical application of fluoride varnish |
804 |
803 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
749 |
723 |
$13K |
| D0272 |
Bitewings - two radiographic images |
506 |
495 |
$7K |
| D0270 |
|
331 |
327 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
23 |
14 |
$1K |
| D1999 |
|
293 |
279 |
$0.00 |