| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,124 |
2,876 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
4,636 |
4,314 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,749 |
3,480 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,457 |
1,342 |
$35K |
| D1120 |
Prophylaxis - child |
1,769 |
1,685 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
836 |
512 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
748 |
663 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
434 |
305 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
546 |
504 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
561 |
534 |
$7K |
| D0272 |
Bitewings - two radiographic images |
554 |
527 |
$7K |
| D0330 |
Panoramic radiographic image |
322 |
303 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
540 |
485 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
45 |
27 |
$4K |
| D1351 |
Sealant - per tooth |
750 |
157 |
$3K |
| D2331 |
|
20 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
138 |
88 |
$528.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
24 |
$0.00 |