| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
281 |
233 |
$9K |
| D0330 |
Panoramic radiographic image |
175 |
146 |
$9K |
| D1206 |
Topical application of fluoride varnish |
389 |
323 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
260 |
233 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
286 |
250 |
$6K |
| D0274 |
Bitewings - four radiographic images |
197 |
175 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
81 |
40 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
143 |
126 |
$4K |
| D1120 |
Prophylaxis - child |
154 |
134 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
73 |
32 |
$3K |
| D9920 |
|
65 |
62 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
184 |
161 |
$2K |
| D0272 |
Bitewings - two radiographic images |
82 |
66 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15 |
12 |
$1K |
| D1330 |
|
16 |
16 |
$255.45 |