| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,218 |
5,104 |
$183K |
| D0120 |
Periodic oral evaluation - established patient |
5,586 |
4,902 |
$96K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,307 |
1,745 |
$64K |
| D0274 |
Bitewings - four radiographic images |
3,406 |
2,652 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,140 |
470 |
$52K |
| D1120 |
Prophylaxis - child |
1,572 |
1,531 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,812 |
1,718 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,795 |
1,749 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
728 |
498 |
$20K |
| D0330 |
Panoramic radiographic image |
1,401 |
950 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
361 |
196 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
229 |
101 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,167 |
973 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
279 |
131 |
$7K |
| D1206 |
Topical application of fluoride varnish |
443 |
427 |
$7K |
| D2931 |
|
26 |
24 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
122 |
106 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
244 |
147 |
$541.51 |
| D7140 |
Extraction, erupted tooth or exposed root |
33 |
13 |
$0.00 |