| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
11,462 |
11,460 |
$367K |
| D0120 |
Periodic oral evaluation - established patient |
14,293 |
14,290 |
$264K |
| D0220 |
Intraoral - periapical first radiographic image |
15,264 |
15,132 |
$132K |
| D0274 |
Bitewings - four radiographic images |
7,283 |
7,283 |
$124K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,433 |
14,250 |
$111K |
| D1120 |
Prophylaxis - child |
2,692 |
2,691 |
$77K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,487 |
6,485 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
3,377 |
3,362 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,143 |
705 |
$42K |
| D2160 |
|
613 |
544 |
$38K |
| D1351 |
Sealant - per tooth |
614 |
277 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
872 |
770 |
$30K |
| D0272 |
Bitewings - two radiographic images |
2,902 |
2,900 |
$27K |
| D4341 |
|
484 |
313 |
$24K |
| D9110 |
|
1,778 |
1,748 |
$24K |
| D2331 |
|
427 |
294 |
$24K |
| D2752 |
|
66 |
60 |
$23K |
| D2161 |
|
208 |
192 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
181 |
129 |
$12K |
| D2954 |
|
46 |
43 |
$4K |
| D2140 |
|
61 |
53 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
26 |
26 |
$2K |