| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,896 |
2,882 |
$242K |
| D9110 |
|
2,747 |
2,672 |
$172K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,409 |
2,396 |
$149K |
| D0120 |
Periodic oral evaluation - established patient |
1,973 |
1,962 |
$106K |
| D0210 |
Intraoral - complete series of radiographic images |
1,935 |
1,921 |
$90K |
| D1120 |
Prophylaxis - child |
1,257 |
1,255 |
$44K |
| D4341 |
|
522 |
141 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,449 |
1,446 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,082 |
1,517 |
$17K |
| D1206 |
Topical application of fluoride varnish |
1,195 |
1,193 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
903 |
892 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
127 |
63 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
69 |
52 |
$8K |
| D1351 |
Sealant - per tooth |
141 |
29 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
27 |
13 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
17 |
17 |
$192.00 |