| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,864 |
1,799 |
$70K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
656 |
431 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
1,780 |
1,657 |
$62K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
382 |
260 |
$47K |
| D7140 |
Extraction, erupted tooth or exposed root |
732 |
307 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,715 |
1,658 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
916 |
885 |
$38K |
| D0330 |
Panoramic radiographic image |
494 |
477 |
$28K |
| D2394 |
|
154 |
107 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,282 |
1,245 |
$21K |
| D1120 |
Prophylaxis - child |
700 |
687 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,298 |
1,242 |
$19K |
| D0274 |
Bitewings - four radiographic images |
480 |
456 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
200 |
192 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
168 |
88 |
$12K |
| D2335 |
|
68 |
39 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
45 |
26 |
$4K |
| D2332 |
|
22 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
109 |
109 |
$2K |
| D4355 |
|
30 |
28 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
66 |
26 |
$814.70 |