| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
907 |
845 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,350 |
1,258 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
299 |
198 |
$19K |
| D0274 |
Bitewings - four radiographic images |
771 |
723 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
320 |
214 |
$16K |
| D1120 |
Prophylaxis - child |
663 |
612 |
$15K |
| D1206 |
Topical application of fluoride varnish |
965 |
889 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
559 |
522 |
$11K |
| D2752 |
|
14 |
12 |
$6K |
| D4341 |
|
121 |
32 |
$6K |
| D0272 |
Bitewings - two radiographic images |
323 |
299 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
450 |
392 |
$4K |
| D0330 |
Panoramic radiographic image |
143 |
131 |
$3K |
| D4910 |
|
51 |
48 |
$3K |
| D2950 |
|
17 |
13 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
13 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
14 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
139 |
83 |
$908.24 |
| D0145 |
Oral evaluation for a patient under three years of age |
46 |
39 |
$863.88 |
| D0140 |
Limited oral evaluation - problem focused |
43 |
34 |
$728.54 |
| D0601 |
|
108 |
101 |
$480.00 |
| D0603 |
|
87 |
83 |
$390.00 |