| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
3,321 |
1,236 |
$348K |
| D1110 |
Prophylaxis - adult |
4,401 |
4,347 |
$165K |
| D4910 |
|
2,610 |
2,582 |
$161K |
| D0120 |
Periodic oral evaluation - established patient |
6,615 |
6,543 |
$122K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,273 |
7,184 |
$113K |
| D0210 |
Intraoral - complete series of radiographic images |
2,083 |
2,054 |
$110K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,078 |
4,026 |
$100K |
| D0274 |
Bitewings - four radiographic images |
3,252 |
3,220 |
$81K |
| D1120 |
Prophylaxis - child |
2,123 |
2,093 |
$59K |
| D1206 |
Topical application of fluoride varnish |
2,356 |
2,328 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
403 |
274 |
$30K |
| D0330 |
Panoramic radiographic image |
573 |
566 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,246 |
2,216 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
403 |
250 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,503 |
1,463 |
$12K |
| D0272 |
Bitewings - two radiographic images |
577 |
566 |
$10K |
| D1351 |
Sealant - per tooth |
347 |
104 |
$8K |
| D0602 |
|
1,199 |
1,183 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
76 |
50 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
69 |
41 |
$4K |
| D0603 |
|
613 |
609 |
$3K |
| D2140 |
|
37 |
17 |
$2K |