| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,930 |
2,688 |
$92K |
| D0274 |
Bitewings - four radiographic images |
3,328 |
3,041 |
$80K |
| D1351 |
Sealant - per tooth |
2,868 |
464 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
3,503 |
3,229 |
$63K |
| D1120 |
Prophylaxis - child |
1,559 |
1,436 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,849 |
1,690 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,549 |
1,408 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
3,570 |
3,266 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,129 |
2,621 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
369 |
211 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
226 |
76 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
274 |
143 |
$12K |
| D1206 |
Topical application of fluoride varnish |
735 |
686 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
252 |
242 |
$10K |
| D0272 |
Bitewings - two radiographic images |
696 |
624 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
338 |
295 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
37 |
29 |
$2K |