| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
989 |
973 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,113 |
1,101 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
142 |
122 |
$9K |
| D0274 |
Bitewings - four radiographic images |
226 |
221 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
96 |
80 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
84 |
70 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
402 |
392 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
104 |
103 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
118 |
116 |
$2K |
| D0330 |
Panoramic radiographic image |
54 |
54 |
$2K |
| D1120 |
Prophylaxis - child |
79 |
78 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$897.00 |
| D9110 |
|
30 |
29 |
$624.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
49 |
48 |
$342.35 |
| D0431 |
|
330 |
322 |
$0.00 |