| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
4,090 |
3,930 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
3,898 |
3,774 |
$81K |
| D1120 |
Prophylaxis - child |
1,721 |
1,678 |
$74K |
| D0220 |
Intraoral - periapical first radiographic image |
4,693 |
4,500 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,231 |
4,315 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
677 |
342 |
$34K |
| D1110 |
Prophylaxis - adult |
906 |
857 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
397 |
384 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,324 |
2,253 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
747 |
718 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
473 |
225 |
$17K |
| D1351 |
Sealant - per tooth |
315 |
71 |
$7K |
| D0999 |
Unspecified diagnostic procedure, by report |
138 |
138 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
79 |
42 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
59 |
55 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
15 |
15 |
$2K |
| D1999 |
|
55 |
53 |
$780.00 |
| D0190 |
|
28 |
28 |
$419.14 |