| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,104 |
3,104 |
$212K |
| D0120 |
Periodic oral evaluation - established patient |
1,850 |
1,850 |
$62K |
| D1120 |
Prophylaxis - child |
700 |
700 |
$35K |
| D0274 |
Bitewings - four radiographic images |
797 |
797 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
188 |
181 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,390 |
1,362 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,189 |
1,189 |
$20K |
| D0330 |
Panoramic radiographic image |
258 |
258 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
205 |
205 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
247 |
247 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
14 |
13 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
67 |
66 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
30 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
193 |
192 |
$3K |
| D2394 |
|
12 |
12 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
39 |
39 |
$3K |
| D0272 |
Bitewings - two radiographic images |
92 |
92 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26 |
26 |
$218.40 |
| D1999 |
|
93 |
85 |
$0.00 |