| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,364 |
1,353 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
1,929 |
1,907 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
373 |
244 |
$41K |
| D0330 |
Panoramic radiographic image |
546 |
543 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,032 |
1,940 |
$30K |
| D1120 |
Prophylaxis - child |
1,122 |
1,108 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
700 |
690 |
$30K |
| D1206 |
Topical application of fluoride varnish |
1,745 |
1,720 |
$28K |
| D0274 |
Bitewings - four radiographic images |
803 |
792 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
661 |
636 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
269 |
172 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,682 |
1,415 |
$21K |
| D0272 |
Bitewings - two radiographic images |
573 |
563 |
$11K |
| D1351 |
Sealant - per tooth |
272 |
81 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
33 |
25 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
13 |
$2K |
| D2394 |
|
13 |
12 |
$2K |
| D9110 |
|
52 |
49 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
55 |
54 |
$883.04 |
| D4355 |
|
12 |
12 |
$762.48 |