| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,215 |
2,199 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
2,084 |
2,067 |
$40K |
| D0274 |
Bitewings - four radiographic images |
788 |
780 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
317 |
239 |
$20K |
| D1330 |
|
1,629 |
1,613 |
$15K |
| D1310 |
|
1,622 |
1,606 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
283 |
232 |
$14K |
| D1206 |
Topical application of fluoride varnish |
811 |
803 |
$14K |
| D9110 |
|
404 |
393 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
191 |
190 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
459 |
411 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
763 |
740 |
$6K |
| D1120 |
Prophylaxis - child |
174 |
172 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
248 |
247 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
72 |
54 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
57 |
39 |
$4K |
| D0330 |
Panoramic radiographic image |
44 |
44 |
$1K |
| D0272 |
Bitewings - two radiographic images |
29 |
26 |
$482.10 |
| D1320 |
|
18 |
18 |
$313.30 |
| D0270 |
|
38 |
38 |
$300.35 |