| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,372 |
6,261 |
$351K |
| D0274 |
Bitewings - four radiographic images |
5,808 |
5,713 |
$222K |
| D0120 |
Periodic oral evaluation - established patient |
7,366 |
7,282 |
$184K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,936 |
1,173 |
$159K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,385 |
1,264 |
$148K |
| D1120 |
Prophylaxis - child |
2,829 |
2,771 |
$142K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,289 |
4,247 |
$125K |
| D0220 |
Intraoral - periapical first radiographic image |
6,568 |
6,223 |
$108K |
| D0140 |
Limited oral evaluation - problem focused |
2,064 |
1,991 |
$82K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,676 |
1,624 |
$70K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,951 |
4,595 |
$68K |
| D4342 |
|
802 |
307 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
846 |
836 |
$60K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
360 |
174 |
$38K |
| D9110 |
|
885 |
849 |
$36K |
| D1351 |
Sealant - per tooth |
863 |
273 |
$34K |
| D2740 |
Crown - porcelain/ceramic |
38 |
26 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
245 |
112 |
$20K |
| D4341 |
|
94 |
35 |
$12K |
| D2332 |
|
48 |
14 |
$5K |
| D0272 |
Bitewings - two radiographic images |
25 |
25 |
$704.00 |