| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
8,231 |
7,715 |
$429K |
| D0210 |
Intraoral - complete series of radiographic images |
3,122 |
2,996 |
$225K |
| D0274 |
Bitewings - four radiographic images |
6,188 |
5,802 |
$218K |
| D0120 |
Periodic oral evaluation - established patient |
9,295 |
8,747 |
$213K |
| D1120 |
Prophylaxis - child |
2,618 |
2,546 |
$133K |
| D1206 |
Topical application of fluoride varnish |
4,700 |
4,495 |
$118K |
| D0140 |
Limited oral evaluation - problem focused |
1,708 |
1,634 |
$67K |
| D7140 |
Extraction, erupted tooth or exposed root |
906 |
614 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,409 |
1,379 |
$64K |
| D1351 |
Sealant - per tooth |
1,389 |
423 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
605 |
346 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
420 |
271 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
1,482 |
1,423 |
$22K |
| D0272 |
Bitewings - two radiographic images |
543 |
536 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
40 |
25 |
$3K |
| D7111 |
|
32 |
24 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
13 |
$197.00 |