| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,680 |
2,548 |
$125K |
| D4212 |
|
313 |
155 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
2,564 |
2,438 |
$56K |
| D0330 |
Panoramic radiographic image |
731 |
701 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,195 |
1,132 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
904 |
858 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
748 |
708 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
235 |
170 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
88 |
39 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,091 |
1,009 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
454 |
427 |
$5K |
| D1120 |
Prophylaxis - child |
142 |
131 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
187 |
97 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
373 |
200 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
44 |
25 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
14 |
$1K |
| D0431 |
|
99 |
93 |
$0.00 |