| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,901 |
2,796 |
$150K |
| D0120 |
Periodic oral evaluation - established patient |
2,555 |
2,497 |
$59K |
| D0274 |
Bitewings - four radiographic images |
1,237 |
1,201 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
979 |
930 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
2,476 |
2,339 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
762 |
715 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,229 |
1,739 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
865 |
851 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
289 |
138 |
$25K |
| D0330 |
Panoramic radiographic image |
298 |
284 |
$20K |
| D1120 |
Prophylaxis - child |
353 |
352 |
$19K |
| D2740 |
Crown - porcelain/ceramic |
16 |
12 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
96 |
41 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
51 |
28 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
43 |
42 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
23 |
14 |
$2K |
| D2394 |
|
16 |
12 |
$2K |