| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,451 |
1,346 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
1,514 |
1,414 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,151 |
1,092 |
$29K |
| D0330 |
Panoramic radiographic image |
473 |
446 |
$17K |
| D1120 |
Prophylaxis - child |
325 |
296 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
545 |
507 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
337 |
129 |
$12K |
| D1206 |
Topical application of fluoride varnish |
825 |
757 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
346 |
328 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
56 |
39 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
399 |
370 |
$3K |
| D2332 |
|
19 |
12 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
12 |
$577.06 |
| D1999 |
|
410 |
337 |
$0.00 |