| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
846 |
807 |
$31K |
| D0274 |
Bitewings - four radiographic images |
638 |
620 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
141 |
121 |
$14K |
| D0330 |
Panoramic radiographic image |
378 |
375 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
586 |
555 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
765 |
679 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
974 |
931 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
345 |
333 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
63 |
54 |
$7K |
| D1330 |
|
780 |
772 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
107 |
107 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
59 |
55 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
168 |
165 |
$4K |
| D9110 |
|
54 |
53 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
14 |
14 |
$1K |
| D1206 |
Topical application of fluoride varnish |
30 |
30 |
$543.46 |