| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,635 |
1,525 |
$112K |
| D1120 |
Prophylaxis - child |
1,438 |
1,343 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
2,661 |
2,480 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
236 |
221 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
67 |
52 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
61 |
42 |
$3K |
| D1351 |
Sealant - per tooth |
3,342 |
634 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
200 |
179 |
$3K |
| D0274 |
Bitewings - four radiographic images |
1,146 |
1,094 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
2,223 |
2,125 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
13 |
$533.38 |
| D0272 |
Bitewings - two radiographic images |
871 |
838 |
$483.67 |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,148 |
2,055 |
$457.10 |
| D1330 |
|
3,116 |
2,911 |
$457.10 |
| D1208 |
Topical application of fluoride, excluding varnish |
3,120 |
2,918 |
$374.36 |