| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,603 |
1,520 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,925 |
1,818 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,023 |
975 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
230 |
164 |
$14K |
| D1120 |
Prophylaxis - child |
219 |
201 |
$9K |
| D0330 |
Panoramic radiographic image |
161 |
159 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
250 |
234 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
72 |
54 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
564 |
540 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
247 |
228 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
45 |
27 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
43 |
26 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
26 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
40 |
39 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
221 |
88 |
$1K |
| D9110 |
|
47 |
43 |
$895.74 |
| D1999 |
|
46 |
41 |
$0.00 |