| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,311 |
2,277 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
870 |
581 |
$60K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
545 |
400 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
2,291 |
2,259 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,824 |
1,809 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,344 |
1,325 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,402 |
1,343 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
169 |
89 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
231 |
229 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
188 |
188 |
$5K |
| D2394 |
|
60 |
56 |
$4K |
| D1120 |
Prophylaxis - child |
101 |
101 |
$4K |
| D4355 |
|
30 |
30 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
24 |
15 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16 |
14 |
$60.81 |