| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,831 |
3,809 |
$148K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,304 |
844 |
$82K |
| D0274 |
Bitewings - four radiographic images |
2,329 |
2,313 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
2,765 |
2,755 |
$60K |
| D0330 |
Panoramic radiographic image |
1,313 |
1,299 |
$51K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
574 |
471 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
728 |
505 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,653 |
1,639 |
$37K |
| D2394 |
|
510 |
427 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,393 |
2,342 |
$20K |
| D2332 |
|
290 |
179 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
800 |
791 |
$16K |
| D9110 |
|
450 |
447 |
$14K |
| D2335 |
|
202 |
123 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
274 |
272 |
$14K |
| D1120 |
Prophylaxis - child |
396 |
395 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,272 |
1,219 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
160 |
101 |
$11K |
| D0272 |
Bitewings - two radiographic images |
343 |
339 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
156 |
152 |
$4K |
| D2330 |
|
74 |
52 |
$4K |
| D1330 |
|
73 |
73 |
$471.60 |
| D0602 |
|
14 |
14 |
$130.00 |