| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,878 |
3,836 |
$211K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,662 |
946 |
$149K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,089 |
2,061 |
$92K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,413 |
787 |
$92K |
| D0140 |
Limited oral evaluation - problem focused |
2,234 |
2,188 |
$90K |
| D0210 |
Intraoral - complete series of radiographic images |
1,154 |
1,140 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
3,088 |
3,058 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
3,911 |
3,790 |
$62K |
| D0274 |
Bitewings - four radiographic images |
1,472 |
1,455 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,743 |
1,721 |
$52K |
| D1120 |
Prophylaxis - child |
995 |
982 |
$52K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
317 |
272 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,364 |
2,167 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
102 |
57 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
80 |
64 |
$8K |
| D1351 |
Sealant - per tooth |
127 |
40 |
$5K |
| D2332 |
|
21 |
12 |
$2K |