| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,633 |
4,556 |
$162K |
| D0274 |
Bitewings - four radiographic images |
4,801 |
4,745 |
$145K |
| D0120 |
Periodic oral evaluation - established patient |
4,975 |
4,908 |
$120K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,225 |
5,167 |
$109K |
| D1120 |
Prophylaxis - child |
1,509 |
1,500 |
$67K |
| D0140 |
Limited oral evaluation - problem focused |
1,721 |
1,673 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,347 |
1,042 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
413 |
281 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,957 |
1,787 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
378 |
221 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,048 |
1,016 |
$11K |
| D0330 |
Panoramic radiographic image |
119 |
117 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
101 |
56 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
45 |
26 |
$5K |
| D0272 |
Bitewings - two radiographic images |
154 |
154 |
$3K |