| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,078 |
1,953 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
2,894 |
2,726 |
$69K |
| D0140 |
Limited oral evaluation - problem focused |
1,747 |
1,488 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
3,386 |
3,126 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,417 |
1,331 |
$42K |
| D1120 |
Prophylaxis - child |
1,507 |
1,444 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
851 |
816 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,818 |
2,512 |
$33K |
| D0330 |
Panoramic radiographic image |
564 |
542 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,724 |
1,639 |
$27K |
| D1351 |
Sealant - per tooth |
774 |
162 |
$22K |
| D9110 |
|
321 |
275 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
131 |
52 |
$8K |
| D0272 |
Bitewings - two radiographic images |
426 |
401 |
$7K |
| D0160 |
|
42 |
36 |
$3K |
| D1206 |
Topical application of fluoride varnish |
170 |
167 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
12 |
$2K |