| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,112 |
5,135 |
$281K |
| D0120 |
Periodic oral evaluation - established patient |
8,365 |
6,965 |
$197K |
| D1120 |
Prophylaxis - child |
4,920 |
4,174 |
$166K |
| D0274 |
Bitewings - four radiographic images |
4,225 |
3,503 |
$124K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,006 |
792 |
$124K |
| D1206 |
Topical application of fluoride varnish |
6,519 |
5,512 |
$122K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,348 |
2,010 |
$104K |
| D0140 |
Limited oral evaluation - problem focused |
2,524 |
2,082 |
$92K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
968 |
755 |
$82K |
| D7140 |
Extraction, erupted tooth or exposed root |
665 |
311 |
$58K |
| D0330 |
Panoramic radiographic image |
1,010 |
779 |
$57K |
| D0210 |
Intraoral - complete series of radiographic images |
458 |
410 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
1,891 |
1,573 |
$31K |
| D1351 |
Sealant - per tooth |
630 |
215 |
$24K |
| D1354 |
|
1,333 |
425 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
111 |
67 |
$4K |
| D2940 |
|
60 |
54 |
$3K |
| D0272 |
Bitewings - two radiographic images |
42 |
40 |
$1K |