| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
9,013 |
8,783 |
$444K |
| D0120 |
Periodic oral evaluation - established patient |
14,994 |
14,796 |
$426K |
| D1120 |
Prophylaxis - child |
9,384 |
9,337 |
$344K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,102 |
1,894 |
$223K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,541 |
9,492 |
$197K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,998 |
1,241 |
$193K |
| D0272 |
Bitewings - two radiographic images |
8,072 |
8,011 |
$178K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,942 |
2,773 |
$136K |
| D1206 |
Topical application of fluoride varnish |
3,545 |
3,526 |
$91K |
| D1351 |
Sealant - per tooth |
1,941 |
465 |
$64K |
| D0140 |
Limited oral evaluation - problem focused |
1,943 |
1,918 |
$63K |
| D0220 |
Intraoral - periapical first radiographic image |
4,267 |
3,860 |
$50K |
| D0274 |
Bitewings - four radiographic images |
1,770 |
1,608 |
$50K |
| D0145 |
Oral evaluation for a patient under three years of age |
636 |
636 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
283 |
122 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,678 |
1,236 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
69 |
65 |
$3K |