| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
611 |
596 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
910 |
891 |
$15K |
| D0274 |
Bitewings - four radiographic images |
728 |
708 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
247 |
125 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
576 |
553 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
248 |
240 |
$6K |
| D1120 |
Prophylaxis - child |
276 |
266 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,017 |
811 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
993 |
960 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
58 |
56 |
$3K |
| D1351 |
Sealant - per tooth |
134 |
30 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
38 |
25 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
41 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
137 |
131 |
$1K |
| D0240 |
|
106 |
43 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
41 |
39 |
$880.62 |