| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
4,908 |
4,892 |
$140K |
| D1120 |
Prophylaxis - child |
3,722 |
3,697 |
$115K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,417 |
734 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,972 |
2,954 |
$101K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,274 |
5,239 |
$94K |
| D1110 |
Prophylaxis - adult |
2,184 |
2,173 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
3,079 |
3,067 |
$66K |
| D9243 |
|
791 |
218 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
823 |
453 |
$44K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
353 |
112 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,303 |
1,277 |
$36K |
| D0330 |
Panoramic radiographic image |
915 |
914 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,469 |
2,400 |
$27K |
| D4346 |
|
80 |
80 |
$9K |
| D9239 |
|
166 |
166 |
$9K |
| D7240 |
Removal of impacted tooth - completely bony |
43 |
12 |
$7K |
| D9610 |
|
213 |
213 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
444 |
425 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
25 |
13 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
37 |
37 |
$1K |
| D9110 |
|
17 |
16 |
$897.96 |
| D0272 |
Bitewings - two radiographic images |
40 |
40 |
$822.39 |