| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,477 |
1,423 |
$66K |
| D0330 |
Panoramic radiographic image |
1,783 |
1,714 |
$64K |
| D1110 |
Prophylaxis - adult |
1,465 |
1,427 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,212 |
2,117 |
$53K |
| D0274 |
Bitewings - four radiographic images |
2,060 |
1,995 |
$46K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
601 |
246 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,929 |
1,866 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
683 |
653 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
938 |
915 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
838 |
799 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
22 |
22 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
237 |
178 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
13 |
$1K |
| D1206 |
Topical application of fluoride varnish |
30 |
30 |
$405.00 |