| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
422 |
395 |
$13K |
| D0274 |
Bitewings - four radiographic images |
389 |
365 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
491 |
464 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
132 |
89 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
601 |
551 |
$4K |
| D9110 |
|
154 |
139 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
552 |
508 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
109 |
103 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
70 |
67 |
$1K |
| D0330 |
Panoramic radiographic image |
39 |
32 |
$982.74 |
| D7140 |
Extraction, erupted tooth or exposed root |
15 |
13 |
$682.50 |
| D0602 |
|
43 |
41 |
$380.00 |
| D1330 |
|
49 |
47 |
$277.94 |
| D1120 |
Prophylaxis - child |
16 |
16 |
$239.25 |