| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,623 |
3,533 |
$151K |
| D0120 |
Periodic oral evaluation - established patient |
4,532 |
4,437 |
$98K |
| D0274 |
Bitewings - four radiographic images |
3,058 |
2,987 |
$92K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,625 |
3,552 |
$65K |
| D1120 |
Prophylaxis - child |
1,997 |
1,956 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
1,973 |
1,869 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
622 |
373 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
446 |
284 |
$35K |
| D1351 |
Sealant - per tooth |
1,408 |
208 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
345 |
187 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,218 |
2,055 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
761 |
740 |
$22K |
| D0272 |
Bitewings - two radiographic images |
956 |
936 |
$20K |
| D0330 |
Panoramic radiographic image |
273 |
264 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
70 |
68 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
319 |
204 |
$3K |
| D0240 |
|
78 |
39 |
$1K |
| D1999 |
|
3,382 |
2,849 |
$0.00 |