| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,167 |
3,134 |
$104K |
| D0274 |
Bitewings - four radiographic images |
3,736 |
3,687 |
$95K |
| D1351 |
Sealant - per tooth |
3,138 |
465 |
$82K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,165 |
492 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
3,328 |
3,290 |
$64K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,434 |
4,066 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
735 |
464 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,101 |
2,071 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
4,675 |
4,575 |
$35K |
| D1120 |
Prophylaxis - child |
949 |
939 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
882 |
878 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
291 |
284 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
193 |
110 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
197 |
197 |
$9K |
| D1206 |
Topical application of fluoride varnish |
339 |
337 |
$6K |
| D0272 |
Bitewings - two radiographic images |
339 |
333 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
16 |
$2K |
| D4341 |
|
27 |
12 |
$2K |
| D2331 |
|
21 |
12 |
$1K |
| D2330 |
|
16 |
12 |
$815.00 |
| D1999 |
|
170 |
154 |
$259.00 |