| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,847 |
3,845 |
$201K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
981 |
729 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
3,317 |
3,316 |
$87K |
| D0210 |
Intraoral - complete series of radiographic images |
1,308 |
1,303 |
$62K |
| D0274 |
Bitewings - four radiographic images |
1,600 |
1,600 |
$45K |
| D1120 |
Prophylaxis - child |
1,016 |
1,016 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
991 |
990 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,744 |
1,744 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
424 |
311 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,698 |
1,693 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
249 |
150 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
130 |
99 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
757 |
756 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
69 |
54 |
$7K |
| D0330 |
Panoramic radiographic image |
147 |
147 |
$6K |
| D2330 |
|
16 |
13 |
$812.60 |
| D0272 |
Bitewings - two radiographic images |
46 |
46 |
$768.74 |
| D0140 |
Limited oral evaluation - problem focused |
42 |
41 |
$607.00 |