| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,733 |
2,634 |
$94K |
| D0210 |
Intraoral - complete series of radiographic images |
1,286 |
1,229 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
2,887 |
2,814 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
2,304 |
2,199 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
4,598 |
2,493 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
813 |
797 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
467 |
314 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,499 |
1,464 |
$31K |
| D1120 |
Prophylaxis - child |
660 |
642 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
502 |
490 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
42 |
27 |
$5K |
| D2954 |
|
35 |
28 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
37 |
27 |
$4K |
| D0274 |
Bitewings - four radiographic images |
96 |
93 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
242 |
122 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
13 |
$898.70 |