| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,293 |
1,251 |
$52K |
| D0274 |
Bitewings - four radiographic images |
1,591 |
1,540 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,402 |
1,328 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,284 |
2,124 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
303 |
114 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
285 |
198 |
$21K |
| D0330 |
Panoramic radiographic image |
510 |
485 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,927 |
1,739 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
692 |
673 |
$14K |
| D1351 |
Sealant - per tooth |
461 |
54 |
$13K |
| D1206 |
Topical application of fluoride varnish |
594 |
574 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
228 |
214 |
$6K |
| D1120 |
Prophylaxis - child |
103 |
96 |
$3K |