| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,414 |
1,383 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,169 |
2,135 |
$57K |
| D0330 |
Panoramic radiographic image |
1,196 |
1,172 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,428 |
1,404 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
614 |
439 |
$30K |
| D1120 |
Prophylaxis - child |
616 |
588 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
606 |
280 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
700 |
447 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
348 |
268 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,190 |
1,150 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,559 |
1,521 |
$11K |
| D2331 |
|
167 |
134 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
178 |
176 |
$5K |
| D2335 |
|
68 |
50 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
878 |
476 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
93 |
91 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
258 |
230 |
$4K |
| D2330 |
|
77 |
52 |
$3K |
| D2332 |
|
49 |
26 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
21 |
13 |
$1K |
| D9986 |
|
409 |
360 |
$0.00 |