| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,762 |
1,725 |
$87K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
527 |
243 |
$87K |
| D2750 |
|
111 |
87 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
694 |
675 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,332 |
1,308 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
250 |
130 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,183 |
1,177 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
468 |
454 |
$25K |
| D2332 |
|
95 |
45 |
$13K |
| D2950 |
|
108 |
84 |
$9K |
| D0274 |
Bitewings - four radiographic images |
306 |
300 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
80 |
77 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
43 |
25 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
16 |
$3K |
| D4355 |
|
19 |
16 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
151 |
145 |
$1K |
| D1120 |
Prophylaxis - child |
24 |
24 |
$1K |
| D1330 |
|
62 |
61 |
$366.00 |