| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,728 |
6,652 |
$426K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,628 |
880 |
$327K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,780 |
1,281 |
$235K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,116 |
4,052 |
$224K |
| D0330 |
Panoramic radiographic image |
3,495 |
3,454 |
$157K |
| D0120 |
Periodic oral evaluation - established patient |
5,070 |
5,046 |
$155K |
| D1206 |
Topical application of fluoride varnish |
5,391 |
5,323 |
$138K |
| D0274 |
Bitewings - four radiographic images |
5,728 |
5,651 |
$133K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,067 |
786 |
$110K |
| D2750 |
|
229 |
188 |
$110K |
| D0140 |
Limited oral evaluation - problem focused |
2,136 |
2,070 |
$99K |
| D1120 |
Prophylaxis - child |
2,152 |
2,143 |
$94K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,504 |
3,484 |
$80K |
| D0220 |
Intraoral - periapical first radiographic image |
7,428 |
7,184 |
$77K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
345 |
276 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,917 |
4,837 |
$38K |
| D1351 |
Sealant - per tooth |
943 |
117 |
$31K |
| D1330 |
|
2,592 |
2,573 |
$16K |
| D0272 |
Bitewings - two radiographic images |
798 |
794 |
$12K |
| D2950 |
|
134 |
106 |
$11K |
| D2332 |
|
17 |
12 |
$2K |
| D2331 |
|
20 |
16 |
$2K |