| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,085 |
3,868 |
$125K |
| D0210 |
Intraoral - complete series of radiographic images |
2,508 |
2,385 |
$120K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,518 |
1,027 |
$87K |
| D0274 |
Bitewings - four radiographic images |
3,803 |
3,622 |
$75K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,683 |
4,459 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,373 |
2,297 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
3,381 |
3,264 |
$53K |
| D9110 |
|
1,545 |
1,449 |
$40K |
| D1120 |
Prophylaxis - child |
1,618 |
1,563 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,540 |
1,490 |
$32K |
| D1351 |
Sealant - per tooth |
1,758 |
554 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
3,029 |
2,788 |
$25K |
| D4355 |
|
287 |
273 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,787 |
2,073 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
367 |
254 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
325 |
240 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
54 |
38 |
$3K |
| D0330 |
Panoramic radiographic image |
68 |
64 |
$3K |