| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,479 |
1,478 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
1,960 |
1,959 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
396 |
286 |
$34K |
| D1120 |
Prophylaxis - child |
674 |
674 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
224 |
205 |
$21K |
| D2394 |
|
115 |
107 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
140 |
130 |
$16K |
| D0272 |
Bitewings - two radiographic images |
638 |
637 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
140 |
124 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
514 |
514 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
482 |
470 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
188 |
186 |
$6K |
| D0330 |
Panoramic radiographic image |
119 |
118 |
$5K |
| D0274 |
Bitewings - four radiographic images |
105 |
105 |
$3K |
| D2335 |
|
18 |
14 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
97 |
97 |
$2K |
| D1999 |
|
167 |
165 |
$0.00 |