| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2335 |
|
974 |
337 |
$125K |
| D1110 |
Prophylaxis - adult |
2,241 |
2,194 |
$113K |
| D0140 |
Limited oral evaluation - problem focused |
1,152 |
1,087 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,781 |
1,757 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
483 |
336 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
378 |
241 |
$28K |
| D2394 |
|
235 |
142 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,580 |
1,490 |
$23K |
| D0274 |
Bitewings - four radiographic images |
625 |
610 |
$22K |
| D2332 |
|
192 |
123 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
295 |
176 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
212 |
209 |
$15K |
| D2330 |
|
171 |
90 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
220 |
212 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
553 |
385 |
$6K |
| D9110 |
|
75 |
67 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
102 |
94 |
$3K |
| D7311 |
|
17 |
13 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
27 |
25 |
$1K |