| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,508 |
4,084 |
$129K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,430 |
5,911 |
$109K |
| D0120 |
Periodic oral evaluation - established patient |
4,601 |
4,270 |
$95K |
| D0210 |
Intraoral - complete series of radiographic images |
2,007 |
1,805 |
$95K |
| D0274 |
Bitewings - four radiographic images |
3,349 |
3,068 |
$89K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,434 |
844 |
$88K |
| D1120 |
Prophylaxis - child |
1,737 |
1,588 |
$69K |
| D0140 |
Limited oral evaluation - problem focused |
2,821 |
2,523 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,947 |
1,657 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
716 |
397 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
1,896 |
1,686 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
229 |
158 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
90 |
42 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
49 |
25 |
$3K |
| D1351 |
Sealant - per tooth |
63 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
40 |
24 |
$312.80 |
| D0602 |
|
12 |
12 |
$0.00 |
| D0601 |
|
41 |
36 |
$0.00 |
| D0603 |
|
144 |
87 |
$0.00 |