| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,003 |
2,947 |
$158K |
| D0120 |
Periodic oral evaluation - established patient |
4,134 |
4,076 |
$100K |
| D1120 |
Prophylaxis - child |
1,300 |
1,291 |
$66K |
| D1206 |
Topical application of fluoride varnish |
2,164 |
2,146 |
$57K |
| D0274 |
Bitewings - four radiographic images |
1,482 |
1,467 |
$53K |
| D9110 |
|
548 |
539 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,307 |
1,282 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
345 |
343 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
190 |
187 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
150 |
92 |
$12K |
| D0330 |
Panoramic radiographic image |
154 |
152 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
689 |
679 |
$9K |
| D1351 |
Sealant - per tooth |
82 |
27 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
59 |
59 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
14 |
12 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
14 |
$1K |
| D0272 |
Bitewings - two radiographic images |
24 |
24 |
$696.00 |