| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
8,628 |
8,594 |
$328K |
| D0120 |
Periodic oral evaluation - established patient |
10,952 |
10,915 |
$242K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,751 |
1,494 |
$150K |
| D1120 |
Prophylaxis - child |
2,997 |
2,995 |
$121K |
| D0274 |
Bitewings - four radiographic images |
4,150 |
4,132 |
$108K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,145 |
1,055 |
$105K |
| D2750 |
|
157 |
148 |
$94K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,785 |
3,781 |
$92K |
| D0220 |
Intraoral - periapical first radiographic image |
6,985 |
6,785 |
$73K |
| D0272 |
Bitewings - two radiographic images |
2,630 |
2,625 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,085 |
763 |
$52K |
| D2394 |
|
432 |
403 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
602 |
479 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
905 |
900 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,555 |
3,057 |
$31K |
| D4341 |
|
134 |
43 |
$19K |
| D2335 |
|
75 |
66 |
$7K |