| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
863 |
843 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,062 |
856 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
1,149 |
1,133 |
$24K |
| D8670 |
Periodic orthodontic treatment visit |
55 |
54 |
$24K |
| D0274 |
Bitewings - four radiographic images |
705 |
692 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
906 |
889 |
$19K |
| D0330 |
Panoramic radiographic image |
431 |
289 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
723 |
539 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
144 |
76 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
260 |
215 |
$11K |
| D1120 |
Prophylaxis - child |
272 |
271 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
104 |
19 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
836 |
660 |
$7K |
| D9630 |
|
268 |
266 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
41 |
25 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
24 |
13 |
$3K |
| D9310 |
|
42 |
31 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
63 |
24 |
$506.12 |
| D1999 |
|
73 |
68 |
$0.00 |