| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,738 |
2,680 |
$179K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
988 |
542 |
$122K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,621 |
1,575 |
$105K |
| D0330 |
Panoramic radiographic image |
1,457 |
1,420 |
$93K |
| D0274 |
Bitewings - four radiographic images |
2,070 |
2,023 |
$77K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,226 |
3,149 |
$76K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
755 |
413 |
$71K |
| D0140 |
Limited oral evaluation - problem focused |
1,412 |
1,356 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
1,963 |
1,920 |
$59K |
| D4341 |
|
419 |
157 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
1,484 |
1,378 |
$21K |
| D9944 |
|
41 |
41 |
$20K |
| D2750 |
|
34 |
24 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
116 |
87 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
38 |
26 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
251 |
190 |
$4K |
| D0460 |
|
105 |
100 |
$3K |
| D1120 |
Prophylaxis - child |
62 |
62 |
$3K |