| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,054 |
2,049 |
$116K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,714 |
1,699 |
$78K |
| D0210 |
Intraoral - complete series of radiographic images |
980 |
971 |
$74K |
| D0274 |
Bitewings - four radiographic images |
1,789 |
1,786 |
$68K |
| D1120 |
Prophylaxis - child |
947 |
945 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
1,945 |
1,945 |
$50K |
| D0140 |
Limited oral evaluation - problem focused |
1,114 |
1,100 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,503 |
1,499 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
2,378 |
2,334 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,890 |
1,646 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
220 |
162 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
290 |
171 |
$19K |
| D1351 |
Sealant - per tooth |
182 |
40 |
$8K |
| D4342 |
|
39 |
16 |
$4K |
| D9110 |
|
60 |
59 |
$3K |
| D2332 |
|
13 |
12 |
$1K |
| D3120 |
|
35 |
25 |
$1K |