| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,361 |
3,342 |
$96K |
| D0274 |
Bitewings - four radiographic images |
2,992 |
2,966 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
4,082 |
4,042 |
$82K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,284 |
2,257 |
$68K |
| D1110 |
Prophylaxis - adult |
2,372 |
2,339 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,602 |
3,582 |
$57K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
719 |
427 |
$56K |
| D0210 |
Intraoral - complete series of radiographic images |
1,042 |
1,022 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
2,949 |
2,889 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
1,057 |
1,046 |
$27K |
| D0272 |
Bitewings - two radiographic images |
924 |
920 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,909 |
1,653 |
$16K |
| D1351 |
Sealant - per tooth |
462 |
142 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
245 |
147 |
$14K |
| D0240 |
|
572 |
423 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
188 |
133 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
63 |
42 |
$6K |