| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,816 |
2,695 |
$118K |
| D0330 |
Panoramic radiographic image |
1,711 |
1,636 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,714 |
2,620 |
$68K |
| D1120 |
Prophylaxis - child |
911 |
877 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
2,044 |
1,921 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,100 |
1,059 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
355 |
183 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
983 |
469 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
646 |
620 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
64 |
55 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
45 |
28 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
59 |
28 |
$3K |
| D1206 |
Topical application of fluoride varnish |
150 |
144 |
$2K |
| D2335 |
|
15 |
12 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
13 |
$846.60 |
| D1208 |
Topical application of fluoride, excluding varnish |
30 |
29 |
$487.35 |