| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,483 |
4,431 |
$280K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,144 |
882 |
$278K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,330 |
817 |
$238K |
| D0120 |
Periodic oral evaluation - established patient |
7,500 |
7,394 |
$224K |
| D1120 |
Prophylaxis - child |
4,753 |
4,677 |
$207K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,412 |
6,316 |
$147K |
| D0210 |
Intraoral - complete series of radiographic images |
1,826 |
1,801 |
$103K |
| D7140 |
Extraction, erupted tooth or exposed root |
782 |
365 |
$92K |
| D0274 |
Bitewings - four radiographic images |
3,192 |
3,150 |
$73K |
| D1206 |
Topical application of fluoride varnish |
2,717 |
2,687 |
$69K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
414 |
243 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,127 |
1,110 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
5,479 |
5,351 |
$54K |
| D1351 |
Sealant - per tooth |
1,357 |
208 |
$45K |
| D2750 |
|
80 |
64 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,109 |
5,029 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,596 |
1,572 |
$24K |
| D1330 |
|
3,918 |
3,854 |
$24K |
| D2332 |
|
110 |
54 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
317 |
301 |
$15K |
| D3320 |
|
13 |
12 |
$8K |
| D2952 |
|
41 |
36 |
$4K |