| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,836 |
1,720 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
2,175 |
2,003 |
$43K |
| D0330 |
Panoramic radiographic image |
600 |
571 |
$37K |
| D0274 |
Bitewings - four radiographic images |
969 |
902 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
671 |
618 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
189 |
77 |
$17K |
| D1206 |
Topical application of fluoride varnish |
833 |
719 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
160 |
135 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
188 |
178 |
$7K |
| D1120 |
Prophylaxis - child |
257 |
225 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
342 |
320 |
$4K |
| D2331 |
|
20 |
12 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
16 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
12 |
$876.90 |