| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,842 |
1,806 |
$90K |
| D1120 |
Prophylaxis - child |
1,667 |
1,645 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,403 |
2,341 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,083 |
686 |
$66K |
| D0330 |
Panoramic radiographic image |
1,334 |
1,294 |
$58K |
| D0274 |
Bitewings - four radiographic images |
1,834 |
1,787 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
1,029 |
1,000 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
811 |
395 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
565 |
395 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
963 |
953 |
$25K |
| D1206 |
Topical application of fluoride varnish |
1,528 |
1,509 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,633 |
1,528 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
112 |
67 |
$7K |
| D0272 |
Bitewings - two radiographic images |
108 |
107 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
30 |
14 |
$2K |
| D2332 |
|
16 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
94 |
59 |
$539.28 |