| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,887 |
3,843 |
$201K |
| D0120 |
Periodic oral evaluation - established patient |
5,558 |
5,490 |
$151K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
748 |
475 |
$102K |
| D1120 |
Prophylaxis - child |
1,867 |
1,844 |
$73K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
708 |
418 |
$66K |
| D0274 |
Bitewings - four radiographic images |
1,984 |
1,961 |
$64K |
| D1206 |
Topical application of fluoride varnish |
3,037 |
3,004 |
$63K |
| D0220 |
Intraoral - periapical first radiographic image |
2,171 |
2,137 |
$41K |
| D4341 |
|
243 |
154 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,021 |
1,012 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,035 |
1,846 |
$19K |
| D0330 |
Panoramic radiographic image |
238 |
235 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
86 |
75 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
12 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15 |
14 |
$1K |
| D1351 |
Sealant - per tooth |
32 |
12 |
$1K |