| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,959 |
4,883 |
$184K |
| D1206 |
Topical application of fluoride varnish |
5,665 |
5,589 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
4,536 |
4,467 |
$86K |
| D0210 |
Intraoral - complete series of radiographic images |
1,091 |
1,079 |
$56K |
| D0274 |
Bitewings - four radiographic images |
3,405 |
3,357 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
621 |
480 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,791 |
1,763 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
4,633 |
4,091 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
820 |
414 |
$40K |
| D3221 |
|
357 |
345 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
435 |
325 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
602 |
579 |
$15K |
| D2330 |
|
282 |
194 |
$14K |
| D1120 |
Prophylaxis - child |
462 |
452 |
$13K |
| D2950 |
|
115 |
110 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
178 |
155 |
$10K |
| D0330 |
Panoramic radiographic image |
1,509 |
1,489 |
$9K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
26 |
24 |
$9K |
| D2331 |
|
131 |
101 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
82 |
75 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
796 |
630 |
$5K |
| D2332 |
|
48 |
39 |
$4K |
| D4341 |
|
25 |
12 |
$3K |
| D0272 |
Bitewings - two radiographic images |
181 |
173 |
$2K |
| D2160 |
|
26 |
25 |
$2K |
| D1351 |
Sealant - per tooth |
69 |
14 |
$2K |
| D2140 |
|
19 |
14 |
$799.36 |
| D0460 |
|
120 |
112 |
$478.16 |