| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,498 |
1,492 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,653 |
1,643 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
795 |
793 |
$63K |
| D1351 |
Sealant - per tooth |
1,136 |
266 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,616 |
1,615 |
$38K |
| D1206 |
Topical application of fluoride varnish |
1,591 |
1,584 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
269 |
71 |
$26K |
| D1120 |
Prophylaxis - child |
707 |
704 |
$22K |
| D0274 |
Bitewings - four radiographic images |
643 |
643 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
181 |
99 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
122 |
84 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
518 |
513 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,061 |
1,054 |
$13K |
| D0272 |
Bitewings - two radiographic images |
51 |
51 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
26 |
25 |
$873.92 |
| D0240 |
|
17 |
17 |
$631.29 |