| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,018 |
2,014 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
1,489 |
1,485 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
520 |
345 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,284 |
1,280 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
664 |
658 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,893 |
1,868 |
$16K |
| D9310 |
|
363 |
362 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
634 |
634 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
156 |
74 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
232 |
145 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,358 |
1,347 |
$8K |
| D0330 |
Panoramic radiographic image |
229 |
229 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
286 |
282 |
$3K |
| D1120 |
Prophylaxis - child |
96 |
96 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
184 |
184 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
14 |
$1K |