| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
2,711 |
2,659 |
$66K |
| D1110 |
Prophylaxis - adult |
1,899 |
1,867 |
$62K |
| D7140 |
Extraction, erupted tooth or exposed root |
811 |
443 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,161 |
2,129 |
$45K |
| D1351 |
Sealant - per tooth |
1,454 |
240 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,054 |
2,644 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,672 |
1,649 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
544 |
358 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
437 |
275 |
$25K |
| D1120 |
Prophylaxis - child |
803 |
798 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
3,114 |
3,030 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
393 |
375 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
606 |
602 |
$11K |
| D1206 |
Topical application of fluoride varnish |
472 |
470 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
144 |
141 |
$6K |
| D0272 |
Bitewings - two radiographic images |
106 |
106 |
$2K |
| D2330 |
|
31 |
15 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
18 |
$2K |
| D1999 |
|
13 |
13 |
$0.00 |