| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,489 |
4,487 |
$145K |
| D0120 |
Periodic oral evaluation - established patient |
4,655 |
4,653 |
$87K |
| D0220 |
Intraoral - periapical first radiographic image |
6,672 |
6,612 |
$60K |
| D0274 |
Bitewings - four radiographic images |
3,381 |
3,379 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,868 |
5,821 |
$55K |
| D1120 |
Prophylaxis - child |
1,916 |
1,915 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,102 |
2,102 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
2,543 |
2,488 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,978 |
1,978 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
125 |
94 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
808 |
791 |
$7K |
| D0272 |
Bitewings - two radiographic images |
482 |
482 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
64 |
50 |
$3K |
| D2335 |
|
14 |
12 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
28 |
27 |
$2K |
| D0330 |
Panoramic radiographic image |
115 |
115 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
15 |
$733.94 |
| D1999 |
|
387 |
375 |
$10.00 |