| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,989 |
2,753 |
$71K |
| D0210 |
Intraoral - complete series of radiographic images |
1,032 |
935 |
$38K |
| D1206 |
Topical application of fluoride varnish |
2,528 |
2,365 |
$31K |
| D9110 |
|
1,633 |
1,359 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
2,023 |
1,875 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,382 |
1,245 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
1,590 |
1,454 |
$22K |
| D0274 |
Bitewings - four radiographic images |
1,122 |
1,036 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
403 |
181 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,042 |
918 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
257 |
149 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,391 |
1,233 |
$8K |
| D0170 |
|
466 |
409 |
$7K |
| D1351 |
Sealant - per tooth |
422 |
77 |
$5K |
| D4355 |
|
71 |
54 |
$3K |
| D1120 |
Prophylaxis - child |
136 |
108 |
$2K |
| D2931 |
|
15 |
12 |
$1K |
| D2940 |
|
15 |
12 |
$311.76 |
| D0230 |
Intraoral - periapical each additional radiographic image |
84 |
46 |
$268.45 |