| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,307 |
4,307 |
$209K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,852 |
1,292 |
$179K |
| D0120 |
Periodic oral evaluation - established patient |
5,517 |
5,516 |
$127K |
| D1120 |
Prophylaxis - child |
3,587 |
3,587 |
$125K |
| D0274 |
Bitewings - four radiographic images |
4,017 |
4,017 |
$109K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
942 |
635 |
$109K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,540 |
6,540 |
$106K |
| D0330 |
Panoramic radiographic image |
1,963 |
1,963 |
$94K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,956 |
1,956 |
$78K |
| D0140 |
Limited oral evaluation - problem focused |
1,954 |
1,921 |
$71K |
| D0272 |
Bitewings - two radiographic images |
2,672 |
2,672 |
$50K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
343 |
241 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
1,963 |
1,929 |
$24K |
| D2394 |
|
145 |
120 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
98 |
65 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
99 |
96 |
$1K |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$247.00 |