| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
848 |
828 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
443 |
191 |
$33K |
| D1206 |
Topical application of fluoride varnish |
1,036 |
1,028 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
801 |
782 |
$22K |
| D0330 |
Panoramic radiographic image |
397 |
386 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,477 |
1,416 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
570 |
568 |
$17K |
| D0274 |
Bitewings - four radiographic images |
581 |
562 |
$16K |
| D1120 |
Prophylaxis - child |
553 |
550 |
$15K |
| D1330 |
|
1,287 |
1,251 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,255 |
1,007 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
183 |
75 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
141 |
140 |
$3K |
| D0180 |
|
24 |
24 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
135 |
134 |
$2K |
| D0272 |
Bitewings - two radiographic images |
48 |
48 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
12 |
$1K |
| D1999 |
|
32 |
29 |
$0.00 |