| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,300 |
2,176 |
$103K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
609 |
316 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
3,419 |
3,230 |
$81K |
| D1206 |
Topical application of fluoride varnish |
2,901 |
2,733 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,215 |
1,160 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
2,191 |
2,064 |
$28K |
| D1120 |
Prophylaxis - child |
874 |
816 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
224 |
138 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
229 |
37 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,742 |
1,652 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
97 |
51 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
350 |
321 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
197 |
177 |
$7K |
| D0272 |
Bitewings - two radiographic images |
305 |
275 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
148 |
138 |
$6K |
| D1351 |
Sealant - per tooth |
151 |
43 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
164 |
138 |
$5K |
| D0330 |
Panoramic radiographic image |
44 |
38 |
$2K |