| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,047 |
2,042 |
$171K |
| D0120 |
Periodic oral evaluation - established patient |
1,838 |
1,828 |
$110K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,484 |
3,817 |
$68K |
| D1120 |
Prophylaxis - child |
1,321 |
1,319 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,549 |
3,542 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
549 |
547 |
$34K |
| D4341 |
|
444 |
119 |
$31K |
| D0272 |
Bitewings - two radiographic images |
2,243 |
2,234 |
$26K |
| D9430 |
|
764 |
759 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
302 |
182 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,741 |
1,732 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
351 |
349 |
$16K |
| D4910 |
|
106 |
106 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
56 |
39 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
44 |
27 |
$2K |
| D2332 |
|
20 |
13 |
$2K |