| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,225 |
2,065 |
$72K |
| D0274 |
Bitewings - four radiographic images |
1,757 |
1,629 |
$43K |
| D1351 |
Sealant - per tooth |
1,681 |
215 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,682 |
1,572 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
617 |
306 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
504 |
279 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,241 |
1,165 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
324 |
89 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,979 |
1,888 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,804 |
1,594 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
651 |
635 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
207 |
206 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
409 |
388 |
$8K |
| D1120 |
Prophylaxis - child |
311 |
311 |
$7K |
| D0330 |
Panoramic radiographic image |
109 |
107 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$834.70 |
| D1330 |
|
94 |
94 |
$475.00 |
| D9110 |
|
12 |
12 |
$315.15 |