| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,944 |
2,943 |
$106K |
| D0210 |
Intraoral - complete series of radiographic images |
2,413 |
2,283 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,172 |
2,172 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,567 |
1,566 |
$30K |
| D2750 |
|
80 |
62 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,459 |
1,458 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
3,112 |
2,981 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,946 |
1,937 |
$13K |
| D2954 |
|
121 |
112 |
$12K |
| D2932 |
|
153 |
136 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
110 |
91 |
$6K |
| D9110 |
|
388 |
382 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
55 |
29 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
94 |
94 |
$913.89 |
| D1208 |
Topical application of fluoride, excluding varnish |
40 |
40 |
$442.00 |
| D1999 |
|
12 |
12 |
$0.00 |
| D7311 |
|
12 |
12 |
$0.00 |