| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,109 |
2,081 |
$66K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,203 |
585 |
$62K |
| D9110 |
|
1,477 |
1,334 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
2,068 |
2,036 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
923 |
412 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,292 |
1,264 |
$32K |
| D0330 |
Panoramic radiographic image |
636 |
633 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
759 |
739 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
699 |
692 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
175 |
100 |
$10K |
| D1120 |
Prophylaxis - child |
228 |
221 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
678 |
648 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
406 |
292 |
$3K |
| D1206 |
Topical application of fluoride varnish |
189 |
188 |
$3K |
| D1330 |
|
528 |
521 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
49 |
41 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
138 |
129 |
$2K |
| D1310 |
|
242 |
240 |
$2K |
| D2332 |
|
18 |
12 |
$1K |
| D0602 |
|
102 |
97 |
$910.00 |
| D9995 |
|
112 |
112 |
$560.00 |
| D0601 |
|
57 |
57 |
$510.00 |