| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,142 |
2,060 |
$104K |
| D0140 |
Limited oral evaluation - problem focused |
1,904 |
1,792 |
$88K |
| D2752 |
|
129 |
91 |
$79K |
| D0210 |
Intraoral - complete series of radiographic images |
1,425 |
1,420 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,289 |
2,195 |
$61K |
| D0330 |
Panoramic radiographic image |
2,891 |
2,781 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,944 |
1,869 |
$49K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
437 |
190 |
$43K |
| D1120 |
Prophylaxis - child |
712 |
673 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,116 |
1,068 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
434 |
238 |
$25K |
| D1206 |
Topical application of fluoride varnish |
769 |
713 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
240 |
66 |
$14K |
| D0274 |
Bitewings - four radiographic images |
2,064 |
1,988 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,931 |
1,838 |
$6K |
| D4341 |
|
69 |
25 |
$5K |
| D2954 |
|
18 |
15 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
35 |
26 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,403 |
668 |
$1K |
| D0601 |
|
45 |
30 |
$290.00 |
| D0270 |
|
73 |
71 |
$282.00 |
| D0272 |
Bitewings - two radiographic images |
37 |
28 |
$164.00 |