| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,118 |
3,851 |
$206K |
| D0120 |
Periodic oral evaluation - established patient |
5,048 |
4,734 |
$113K |
| D0274 |
Bitewings - four radiographic images |
2,241 |
2,093 |
$78K |
| D0220 |
Intraoral - periapical first radiographic image |
4,345 |
4,040 |
$68K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,061 |
637 |
$67K |
| D1120 |
Prophylaxis - child |
1,228 |
1,175 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,131 |
2,058 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,092 |
3,213 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
691 |
644 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
586 |
353 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
502 |
467 |
$22K |
| D1351 |
Sealant - per tooth |
475 |
145 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
399 |
379 |
$15K |
| D2740 |
Crown - porcelain/ceramic |
15 |
14 |
$11K |
| D0272 |
Bitewings - two radiographic images |
370 |
352 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
39 |
28 |
$6K |
| D4342 |
|
52 |
25 |
$5K |