| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,310 |
2,187 |
$82K |
| D0240 |
|
7,482 |
2,968 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
4,096 |
3,873 |
$76K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,549 |
4,268 |
$72K |
| D1351 |
Sealant - per tooth |
3,419 |
667 |
$71K |
| D1120 |
Prophylaxis - child |
2,848 |
2,671 |
$59K |
| D0330 |
Panoramic radiographic image |
999 |
940 |
$45K |
| D0272 |
Bitewings - two radiographic images |
2,969 |
2,801 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
387 |
198 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
582 |
549 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
208 |
136 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
72 |
40 |
$4K |
| D2140 |
|
22 |
14 |
$924.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$295.81 |