| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4342 |
|
4,820 |
1,870 |
$495K |
| D4910 |
|
5,979 |
5,722 |
$446K |
| D1110 |
Prophylaxis - adult |
2,241 |
2,218 |
$103K |
| D1206 |
Topical application of fluoride varnish |
4,478 |
4,250 |
$95K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,997 |
3,922 |
$94K |
| D0274 |
Bitewings - four radiographic images |
2,563 |
2,509 |
$78K |
| D0220 |
Intraoral - periapical first radiographic image |
4,519 |
4,424 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
1,923 |
1,874 |
$51K |
| D0180 |
|
1,105 |
1,095 |
$50K |
| D1120 |
Prophylaxis - child |
1,374 |
1,359 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
351 |
338 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
124 |
79 |
$17K |
| D9110 |
|
204 |
177 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
58 |
35 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
68 |
38 |
$7K |
| D0190 |
|
234 |
230 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
79 |
77 |
$3K |
| D1354 |
|
369 |
132 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
73 |
66 |
$2K |
| D1351 |
Sealant - per tooth |
39 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
36 |
36 |
$1K |