| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,912 |
7,775 |
$273K |
| D0120 |
Periodic oral evaluation - established patient |
10,180 |
10,008 |
$234K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,905 |
10,733 |
$210K |
| D0274 |
Bitewings - four radiographic images |
6,063 |
5,978 |
$178K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,989 |
1,724 |
$166K |
| D1120 |
Prophylaxis - child |
3,110 |
3,070 |
$137K |
| D0210 |
Intraoral - complete series of radiographic images |
2,222 |
2,188 |
$135K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,753 |
1,286 |
$128K |
| D0140 |
Limited oral evaluation - problem focused |
2,436 |
2,405 |
$69K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
758 |
611 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,455 |
2,909 |
$35K |
| D2331 |
|
303 |
224 |
$23K |
| D2140 |
|
380 |
273 |
$19K |
| D2330 |
|
343 |
215 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
279 |
212 |
$17K |
| D2160 |
|
78 |
64 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
26 |
12 |
$3K |
| D1351 |
Sealant - per tooth |
74 |
26 |
$3K |
| D0272 |
Bitewings - two radiographic images |
80 |
79 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
127 |
126 |
$1K |