| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,582 |
1,568 |
$134K |
| D0120 |
Periodic oral evaluation - established patient |
1,479 |
1,478 |
$76K |
| D1120 |
Prophylaxis - child |
1,943 |
1,940 |
$73K |
| D9430 |
|
2,281 |
2,227 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,145 |
1,144 |
$72K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,039 |
657 |
$68K |
| D0210 |
Intraoral - complete series of radiographic images |
1,455 |
1,445 |
$66K |
| D4910 |
|
683 |
682 |
$52K |
| D0274 |
Bitewings - four radiographic images |
2,232 |
2,222 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,526 |
3,097 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,658 |
1,655 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
236 |
157 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
522 |
519 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
22 |
12 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
25 |
16 |
$1K |