| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,329 |
2,238 |
$97K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,021 |
824 |
$92K |
| D0330 |
Panoramic radiographic image |
1,767 |
1,705 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,776 |
2,674 |
$68K |
| D0274 |
Bitewings - four radiographic images |
1,930 |
1,859 |
$47K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
681 |
508 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
908 |
841 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
416 |
318 |
$17K |
| D1120 |
Prophylaxis - child |
285 |
279 |
$12K |
| D1206 |
Topical application of fluoride varnish |
706 |
673 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
608 |
588 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
856 |
790 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
262 |
260 |
$7K |
| D2335 |
|
35 |
26 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
468 |
304 |
$3K |
| D1351 |
Sealant - per tooth |
196 |
56 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$760.92 |