| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,369 |
1,351 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
2,040 |
2,016 |
$9K |
| D0274 |
Bitewings - four radiographic images |
1,522 |
1,503 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,695 |
1,676 |
$6K |
| D1120 |
Prophylaxis - child |
747 |
741 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
2,283 |
2,196 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
816 |
778 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
133 |
81 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,562 |
1,441 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
142 |
77 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
166 |
162 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
93 |
93 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
12 |
$562.27 |
| D0272 |
Bitewings - two radiographic images |
51 |
51 |
$125.44 |
| D1999 |
|
13 |
13 |
$0.00 |