| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,800 |
3,762 |
$207K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,899 |
999 |
$175K |
| D1120 |
Prophylaxis - child |
2,075 |
2,051 |
$106K |
| D0330 |
Panoramic radiographic image |
1,443 |
1,438 |
$101K |
| D0274 |
Bitewings - four radiographic images |
2,690 |
2,652 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
3,802 |
3,775 |
$97K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,091 |
2,057 |
$94K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,921 |
2,888 |
$86K |
| D0220 |
Intraoral - periapical first radiographic image |
4,799 |
4,662 |
$79K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,800 |
3,650 |
$52K |
| D9110 |
|
1,122 |
1,111 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
521 |
299 |
$39K |
| D1351 |
Sealant - per tooth |
648 |
142 |
$27K |
| D0272 |
Bitewings - two radiographic images |
146 |
145 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
44 |
25 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$469.00 |