| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,340 |
5,589 |
$295K |
| D0120 |
Periodic oral evaluation - established patient |
10,635 |
9,328 |
$259K |
| D1120 |
Prophylaxis - child |
6,573 |
5,686 |
$230K |
| D1206 |
Topical application of fluoride varnish |
8,706 |
7,546 |
$166K |
| D0274 |
Bitewings - four radiographic images |
3,410 |
3,046 |
$99K |
| D0140 |
Limited oral evaluation - problem focused |
2,044 |
1,765 |
$73K |
| D1351 |
Sealant - per tooth |
2,435 |
723 |
$70K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
538 |
423 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
2,831 |
2,470 |
$46K |
| D0330 |
Panoramic radiographic image |
596 |
523 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
543 |
499 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
315 |
189 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
235 |
194 |
$20K |
| D0272 |
Bitewings - two radiographic images |
511 |
466 |
$12K |
| D1354 |
|
914 |
252 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
13 |
$4K |
| D2940 |
|
42 |
25 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
38 |
37 |
$2K |
| D0270 |
|
18 |
14 |
$143.00 |
| D0603 |
|
29 |
28 |
$0.00 |
| D0602 |
|
58 |
50 |
$0.00 |