| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
809 |
795 |
$38K |
| D0330 |
Panoramic radiographic image |
420 |
416 |
$24K |
| D0274 |
Bitewings - four radiographic images |
517 |
501 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
786 |
785 |
$16K |
| D1206 |
Topical application of fluoride varnish |
590 |
582 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
425 |
396 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
370 |
358 |
$11K |
| D1120 |
Prophylaxis - child |
185 |
185 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
478 |
461 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
32 |
13 |
$3K |
| D1330 |
|
307 |
287 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
157 |
140 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$350.10 |