| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,190 |
3,150 |
$118K |
| D0274 |
Bitewings - four radiographic images |
3,485 |
3,447 |
$100K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,328 |
2,299 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,942 |
3,893 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
3,084 |
3,050 |
$67K |
| D1120 |
Prophylaxis - child |
1,689 |
1,670 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
3,604 |
3,480 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
527 |
310 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
1,312 |
1,269 |
$37K |
| D0330 |
Panoramic radiographic image |
1,174 |
1,157 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
493 |
203 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,470 |
2,367 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
323 |
178 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
70 |
70 |
$3K |
| D1351 |
Sealant - per tooth |
105 |
15 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
70 |
70 |
$1K |
| D9985 |
|
80 |
73 |
$0.00 |