| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,408 |
2,336 |
$81K |
| D7140 |
Extraction, erupted tooth or exposed root |
945 |
513 |
$56K |
| D0274 |
Bitewings - four radiographic images |
1,732 |
1,682 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
2,165 |
2,085 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
716 |
690 |
$30K |
| D9110 |
|
829 |
804 |
$24K |
| D1351 |
Sealant - per tooth |
896 |
143 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,080 |
1,054 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
410 |
250 |
$20K |
| D5214 |
|
36 |
36 |
$18K |
| D0330 |
Panoramic radiographic image |
407 |
393 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
589 |
570 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,311 |
1,263 |
$10K |
| D1120 |
Prophylaxis - child |
326 |
312 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
159 |
104 |
$9K |
| D1330 |
|
606 |
597 |
$4K |
| D1310 |
|
478 |
475 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
459 |
400 |
$4K |
| D0272 |
Bitewings - two radiographic images |
46 |
39 |
$631.20 |