| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,389 |
2,205 |
$129K |
| D0120 |
Periodic oral evaluation - established patient |
3,511 |
3,263 |
$91K |
| D1120 |
Prophylaxis - child |
2,203 |
1,977 |
$81K |
| D0274 |
Bitewings - four radiographic images |
1,242 |
1,136 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,751 |
1,547 |
$38K |
| D0330 |
Panoramic radiographic image |
506 |
464 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
293 |
213 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,432 |
1,315 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
223 |
159 |
$21K |
| D1351 |
Sealant - per tooth |
431 |
25 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
359 |
335 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
128 |
117 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
12 |
$1K |
| D1320 |
|
51 |
46 |
$1K |
| D0272 |
Bitewings - two radiographic images |
38 |
38 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17 |
17 |
$577.50 |
| D1999 |
|
35 |
22 |
$0.00 |