| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,238 |
3,236 |
$161K |
| D0120 |
Periodic oral evaluation - established patient |
4,193 |
4,191 |
$109K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
694 |
434 |
$61K |
| D0210 |
Intraoral - complete series of radiographic images |
1,278 |
1,278 |
$60K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
224 |
154 |
$26K |
| D0274 |
Bitewings - four radiographic images |
758 |
758 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
153 |
66 |
$9K |
| D1120 |
Prophylaxis - child |
179 |
179 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
524 |
523 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
130 |
81 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
40 |
31 |
$4K |
| D2332 |
|
23 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
37 |
37 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
114 |
105 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
31 |
31 |
$930.00 |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$308.00 |