| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,285 |
3,977 |
$120K |
| D0210 |
Intraoral - complete series of radiographic images |
1,897 |
1,745 |
$83K |
| D1206 |
Topical application of fluoride varnish |
5,514 |
5,118 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
3,891 |
3,636 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
3,224 |
2,982 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,265 |
2,079 |
$44K |
| D0272 |
Bitewings - two radiographic images |
2,282 |
2,127 |
$32K |
| D1351 |
Sealant - per tooth |
1,813 |
359 |
$29K |
| D1120 |
Prophylaxis - child |
1,307 |
1,183 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,067 |
982 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
2,058 |
1,846 |
$15K |
| D9110 |
|
485 |
432 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
161 |
104 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
112 |
55 |
$4K |
| D0170 |
|
177 |
169 |
$3K |
| D2394 |
|
30 |
24 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
22 |
12 |
$2K |