| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,795 |
2,703 |
$220K |
| D0120 |
Periodic oral evaluation - established patient |
3,717 |
3,605 |
$193K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
893 |
610 |
$164K |
| D0140 |
Limited oral evaluation - problem focused |
2,215 |
2,074 |
$138K |
| D1120 |
Prophylaxis - child |
1,752 |
1,690 |
$103K |
| D0220 |
Intraoral - periapical first radiographic image |
3,520 |
3,321 |
$84K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
575 |
365 |
$73K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,530 |
1,998 |
$69K |
| D0274 |
Bitewings - four radiographic images |
1,198 |
1,148 |
$68K |
| D1206 |
Topical application of fluoride varnish |
1,766 |
1,712 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
702 |
674 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
937 |
907 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
187 |
183 |
$19K |
| D0330 |
Panoramic radiographic image |
244 |
236 |
$17K |
| D0272 |
Bitewings - two radiographic images |
417 |
406 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
77 |
24 |
$11K |
| D1354 |
|
179 |
157 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
14 |
$4K |
| D2331 |
|
15 |
12 |
$2K |
| D0270 |
|
53 |
51 |
$1K |
| D1351 |
Sealant - per tooth |
32 |
12 |
$1K |