| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,364 |
2,275 |
$98K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,809 |
1,108 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
1,994 |
1,951 |
$44K |
| D1120 |
Prophylaxis - child |
862 |
826 |
$44K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
695 |
476 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
779 |
749 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,364 |
1,280 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,079 |
1,042 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
564 |
362 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
598 |
577 |
$18K |
| D1206 |
Topical application of fluoride varnish |
791 |
779 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,119 |
1,045 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
226 |
218 |
$3K |
| D0330 |
Panoramic radiographic image |
61 |
49 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
66 |
39 |
$2K |
| D2332 |
|
35 |
25 |
$2K |
| D2335 |
|
19 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$255.71 |
| D0230 |
Intraoral - periapical each additional radiographic image |
33 |
12 |
$102.24 |