| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,780 |
5,775 |
$281K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,987 |
844 |
$126K |
| D0120 |
Periodic oral evaluation - established patient |
4,387 |
4,382 |
$112K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,106 |
617 |
$94K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,924 |
3,906 |
$74K |
| D0272 |
Bitewings - two radiographic images |
4,306 |
4,300 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
1,436 |
1,428 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,891 |
1,891 |
$56K |
| D7140 |
Extraction, erupted tooth or exposed root |
914 |
288 |
$50K |
| D0330 |
Panoramic radiographic image |
814 |
814 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,983 |
1,963 |
$24K |
| D0274 |
Bitewings - four radiographic images |
294 |
294 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
545 |
545 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
471 |
467 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
40 |
31 |
$4K |
| D1320 |
|
314 |
314 |
$3K |
| D2330 |
|
29 |
14 |
$1K |
| D1120 |
Prophylaxis - child |
13 |
13 |
$559.00 |