| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,789 |
2,449 |
$126K |
| D0210 |
Intraoral - complete series of radiographic images |
1,620 |
1,430 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,602 |
1,389 |
$70K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
557 |
381 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
2,124 |
1,924 |
$58K |
| D7140 |
Extraction, erupted tooth or exposed root |
554 |
358 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
275 |
162 |
$22K |
| D1120 |
Prophylaxis - child |
489 |
462 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
793 |
739 |
$19K |
| D0274 |
Bitewings - four radiographic images |
424 |
363 |
$12K |
| D0272 |
Bitewings - two radiographic images |
427 |
393 |
$11K |
| D1351 |
Sealant - per tooth |
201 |
73 |
$6K |
| D1206 |
Topical application of fluoride varnish |
190 |
176 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
27 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
19 |
13 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
166 |
151 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
61 |
61 |
$2K |