| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,051 |
1,029 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
459 |
292 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
1,309 |
1,279 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
370 |
169 |
$17K |
| D0274 |
Bitewings - four radiographic images |
857 |
837 |
$16K |
| D0330 |
Panoramic radiographic image |
354 |
344 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
592 |
576 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
696 |
681 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
480 |
463 |
$10K |
| D1120 |
Prophylaxis - child |
474 |
466 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
128 |
99 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,514 |
1,466 |
$7K |
| D1351 |
Sealant - per tooth |
275 |
69 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,203 |
1,073 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
94 |
71 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
84 |
82 |
$4K |
| D0272 |
Bitewings - two radiographic images |
194 |
186 |
$2K |