| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,962 |
3,879 |
$215K |
| D0330 |
Panoramic radiographic image |
2,504 |
2,436 |
$150K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,683 |
2,614 |
$147K |
| D2750 |
|
284 |
194 |
$133K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,893 |
5,770 |
$124K |
| D0120 |
Periodic oral evaluation - established patient |
3,420 |
3,350 |
$89K |
| D0274 |
Bitewings - four radiographic images |
2,928 |
2,860 |
$87K |
| D1120 |
Prophylaxis - child |
1,893 |
1,848 |
$74K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
528 |
309 |
$62K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
421 |
283 |
$55K |
| D2394 |
|
310 |
231 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
397 |
272 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
967 |
907 |
$41K |
| D1351 |
Sealant - per tooth |
841 |
197 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
294 |
172 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
175 |
100 |
$15K |
| D5212 |
|
14 |
14 |
$8K |
| D2335 |
|
61 |
45 |
$8K |
| D5211 |
|
13 |
12 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
462 |
446 |
$6K |
| D0272 |
Bitewings - two radiographic images |
181 |
179 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
90 |
76 |
$1K |