| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,117 |
4,046 |
$186K |
| D0210 |
Intraoral - complete series of radiographic images |
2,711 |
2,684 |
$165K |
| D0120 |
Periodic oral evaluation - established patient |
4,502 |
4,436 |
$160K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,729 |
1,150 |
$154K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,379 |
2,355 |
$84K |
| D1120 |
Prophylaxis - child |
1,962 |
1,940 |
$70K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
715 |
525 |
$69K |
| D0274 |
Bitewings - four radiographic images |
2,203 |
2,180 |
$56K |
| D7140 |
Extraction, erupted tooth or exposed root |
527 |
272 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
3,798 |
3,713 |
$46K |
| D1351 |
Sealant - per tooth |
1,234 |
151 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
585 |
405 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,002 |
1,982 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,661 |
3,297 |
$36K |
| D2750 |
|
30 |
26 |
$16K |
| D0272 |
Bitewings - two radiographic images |
535 |
525 |
$15K |
| D1206 |
Topical application of fluoride varnish |
469 |
452 |
$12K |
| D2394 |
|
55 |
43 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
80 |
78 |
$3K |
| D0330 |
Panoramic radiographic image |
42 |
42 |
$2K |
| D2335 |
|
18 |
13 |
$2K |
| D2332 |
|
19 |
12 |
$1K |
| D2954 |
|
12 |
12 |
$1K |