| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,490 |
1,480 |
$124K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,816 |
764 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
1,576 |
1,568 |
$90K |
| D4910 |
|
1,127 |
1,120 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
944 |
932 |
$59K |
| D4341 |
|
661 |
174 |
$45K |
| D9110 |
|
641 |
618 |
$39K |
| D2330 |
|
433 |
164 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
656 |
650 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,505 |
2,309 |
$30K |
| D1120 |
Prophylaxis - child |
555 |
554 |
$20K |
| D0350 |
|
1,971 |
1,089 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,349 |
1,336 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
286 |
160 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,905 |
1,375 |
$17K |
| D0272 |
Bitewings - two radiographic images |
544 |
539 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
50 |
32 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
95 |
54 |
$5K |