| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,870 |
1,806 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
705 |
472 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
2,200 |
2,148 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
753 |
308 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,571 |
1,526 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
902 |
852 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
857 |
817 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,047 |
1,022 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
319 |
240 |
$15K |
| D0330 |
Panoramic radiographic image |
380 |
351 |
$13K |
| D1120 |
Prophylaxis - child |
665 |
649 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
2,802 |
2,687 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,028 |
1,795 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
247 |
243 |
$9K |
| D1351 |
Sealant - per tooth |
455 |
113 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
157 |
124 |
$9K |
| D0272 |
Bitewings - two radiographic images |
385 |
379 |
$4K |
| D2394 |
|
38 |
25 |
$2K |