| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,341 |
2,333 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
3,021 |
3,014 |
$78K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,729 |
3,718 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
957 |
543 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
715 |
376 |
$34K |
| D9920 |
|
1,188 |
1,101 |
$34K |
| D1120 |
Prophylaxis - child |
1,404 |
1,402 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,668 |
1,665 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
588 |
588 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,219 |
1,202 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
299 |
146 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,434 |
1,405 |
$12K |
| D1999 |
|
443 |
392 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
216 |
204 |
$5K |
| D9999 |
Unspecified adjunctive procedure, by report |
24 |
24 |
$634.34 |
| D9992 |
|
28 |
28 |
$405.00 |