| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,856 |
1,714 |
$144K |
| D0274 |
Bitewings - four radiographic images |
1,879 |
1,721 |
$100K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,472 |
2,217 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,344 |
1,189 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
2,793 |
2,584 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
1,445 |
1,357 |
$60K |
| D0330 |
Panoramic radiographic image |
435 |
403 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
581 |
534 |
$34K |
| D1120 |
Prophylaxis - child |
556 |
523 |
$33K |
| D1206 |
Topical application of fluoride varnish |
595 |
551 |
$15K |
| D2740 |
Crown - porcelain/ceramic |
23 |
16 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
66 |
37 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
13 |
$5K |
| D0272 |
Bitewings - two radiographic images |
95 |
94 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19 |
13 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
48 |
46 |
$1K |