| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,378 |
4,376 |
$222K |
| D1120 |
Prophylaxis - child |
5,658 |
5,658 |
$198K |
| D0120 |
Periodic oral evaluation - established patient |
8,247 |
8,246 |
$192K |
| D0220 |
Intraoral - periapical first radiographic image |
12,452 |
12,399 |
$162K |
| D0274 |
Bitewings - four radiographic images |
5,871 |
5,871 |
$161K |
| D1206 |
Topical application of fluoride varnish |
9,646 |
9,644 |
$160K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,404 |
3,404 |
$139K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,833 |
11,108 |
$120K |
| D1351 |
Sealant - per tooth |
3,463 |
1,096 |
$104K |
| D0272 |
Bitewings - two radiographic images |
3,699 |
3,699 |
$71K |
| D7140 |
Extraction, erupted tooth or exposed root |
722 |
370 |
$60K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
492 |
332 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
307 |
212 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
532 |
526 |
$20K |
| D0330 |
Panoramic radiographic image |
200 |
200 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
53 |
53 |
$3K |
| D9992 |
|
107 |
107 |
$3K |