| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,473 |
1,472 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
700 |
385 |
$68K |
| D0274 |
Bitewings - four radiographic images |
1,722 |
1,721 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
515 |
240 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,768 |
1,767 |
$40K |
| D0330 |
Panoramic radiographic image |
883 |
881 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
316 |
139 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
2,713 |
2,667 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
756 |
756 |
$30K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
148 |
90 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,075 |
1,074 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,051 |
1,395 |
$18K |
| D1120 |
Prophylaxis - child |
450 |
449 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
420 |
419 |
$15K |
| D0272 |
Bitewings - two radiographic images |
644 |
644 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
104 |
66 |
$9K |
| D2394 |
|
18 |
13 |
$3K |
| D1354 |
|
70 |
23 |
$1K |
| D1206 |
Topical application of fluoride varnish |
31 |
31 |
$502.20 |