| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,059 |
5,986 |
$302K |
| D0120 |
Periodic oral evaluation - established patient |
6,819 |
6,726 |
$180K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,147 |
908 |
$106K |
| D1120 |
Prophylaxis - child |
1,931 |
1,904 |
$75K |
| D0274 |
Bitewings - four radiographic images |
2,673 |
2,625 |
$74K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
912 |
677 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
987 |
969 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,059 |
1,023 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
520 |
518 |
$20K |
| D0330 |
Panoramic radiographic image |
480 |
468 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,165 |
1,159 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,238 |
1,202 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
618 |
606 |
$12K |
| D1351 |
Sealant - per tooth |
401 |
69 |
$11K |
| D0272 |
Bitewings - two radiographic images |
248 |
246 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
26 |
24 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
24 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
132 |
112 |
$1K |
| D2331 |
|
14 |
12 |
$1K |