| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,501 |
2,417 |
$91K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,626 |
1,089 |
$80K |
| D0210 |
Intraoral - complete series of radiographic images |
1,410 |
1,352 |
$73K |
| D1120 |
Prophylaxis - child |
1,309 |
1,272 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
2,807 |
2,702 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,845 |
1,772 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
914 |
516 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
617 |
467 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,144 |
1,106 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,256 |
1,219 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
391 |
270 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
345 |
329 |
$9K |
| D4341 |
|
98 |
44 |
$7K |
| D2335 |
|
83 |
54 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
614 |
584 |
$4K |
| D2332 |
|
41 |
27 |
$2K |
| D0272 |
Bitewings - two radiographic images |
89 |
88 |
$1K |
| D2394 |
|
45 |
31 |
$759.60 |