| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,502 |
5,494 |
$196K |
| D0120 |
Periodic oral evaluation - established patient |
7,000 |
6,990 |
$134K |
| D0274 |
Bitewings - four radiographic images |
4,685 |
4,679 |
$88K |
| D1120 |
Prophylaxis - child |
2,844 |
2,842 |
$81K |
| D0220 |
Intraoral - periapical first radiographic image |
7,424 |
7,343 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,966 |
3,960 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,931 |
6,886 |
$37K |
| D1351 |
Sealant - per tooth |
621 |
265 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
697 |
696 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,322 |
1,321 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
395 |
328 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,803 |
1,802 |
$21K |
| D1206 |
Topical application of fluoride varnish |
715 |
715 |
$17K |
| D2140 |
|
271 |
227 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
763 |
745 |
$8K |
| D2394 |
|
57 |
46 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
40 |
36 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
55 |
50 |
$2K |
| D2161 |
|
28 |
19 |
$2K |
| D2335 |
|
24 |
12 |
$2K |