| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9110 |
|
957 |
942 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
1,745 |
1,684 |
$22K |
| D0330 |
Panoramic radiographic image |
940 |
938 |
$17K |
| D0274 |
Bitewings - four radiographic images |
1,261 |
1,259 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
487 |
357 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
912 |
912 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
570 |
297 |
$13K |
| D1206 |
Topical application of fluoride varnish |
1,512 |
1,508 |
$13K |
| D1330 |
|
1,417 |
1,415 |
$10K |
| D1351 |
Sealant - per tooth |
748 |
194 |
$9K |
| D1110 |
Prophylaxis - adult |
510 |
510 |
$9K |
| D9920 |
|
421 |
414 |
$8K |
| D1120 |
Prophylaxis - child |
728 |
728 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
351 |
220 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
629 |
629 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
861 |
835 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
936 |
717 |
$3K |
| D2394 |
|
97 |
69 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
79 |
60 |
$2K |
| D4355 |
|
209 |
209 |
$795.54 |
| D1999 |
|
48 |
40 |
$0.00 |