| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,549 |
4,533 |
$242K |
| D0120 |
Periodic oral evaluation - established patient |
5,375 |
5,363 |
$130K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,077 |
742 |
$86K |
| D1120 |
Prophylaxis - child |
1,666 |
1,663 |
$84K |
| D0220 |
Intraoral - periapical first radiographic image |
4,172 |
4,125 |
$68K |
| D0274 |
Bitewings - four radiographic images |
1,789 |
1,782 |
$67K |
| D0210 |
Intraoral - complete series of radiographic images |
835 |
830 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,125 |
2,122 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
792 |
545 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,081 |
2,950 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
980 |
973 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
888 |
875 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
430 |
241 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
154 |
134 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
35 |
24 |
$5K |
| D1351 |
Sealant - per tooth |
83 |
27 |
$3K |
| D0272 |
Bitewings - two radiographic images |
53 |
53 |
$2K |
| D2330 |
|
20 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
83 |
83 |
$1K |