| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,898 |
1,560 |
$61K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
848 |
346 |
$44K |
| D0330 |
Panoramic radiographic image |
993 |
797 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,993 |
1,626 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,246 |
999 |
$31K |
| D1120 |
Prophylaxis - child |
1,095 |
856 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,087 |
879 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
403 |
156 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,119 |
876 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
404 |
340 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
143 |
66 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
73 |
52 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
61 |
56 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
29 |
15 |
$2K |
| D0272 |
Bitewings - two radiographic images |
132 |
105 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
185 |
149 |
$864.00 |
| D2140 |
|
15 |
12 |
$600.00 |