| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,898 |
1,838 |
$97K |
| D0274 |
Bitewings - four radiographic images |
1,743 |
1,691 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
1,870 |
1,822 |
$45K |
| D0330 |
Panoramic radiographic image |
806 |
772 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,212 |
1,186 |
$35K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
206 |
77 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
654 |
640 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
563 |
535 |
$21K |
| D1120 |
Prophylaxis - child |
396 |
382 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
246 |
158 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
575 |
543 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
73 |
46 |
$5K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$384.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$135.00 |
| D1999 |
|
504 |
463 |
$0.00 |