| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,128 |
1,088 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
2,559 |
1,959 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,082 |
1,402 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,126 |
1,089 |
$19K |
| D0274 |
Bitewings - four radiographic images |
815 |
796 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
733 |
571 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,413 |
487 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
2,034 |
1,330 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
80 |
12 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
115 |
76 |
$12K |
| D4910 |
|
197 |
195 |
$10K |
| D7880 |
|
14 |
13 |
$7K |
| D0330 |
Panoramic radiographic image |
244 |
193 |
$6K |
| D1354 |
|
486 |
210 |
$4K |
| D9994 |
|
653 |
636 |
$4K |
| D9920 |
|
91 |
88 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
54 |
54 |
$792.64 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$402.24 |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$258.00 |
| D9630 |
|
160 |
157 |
$0.00 |
| D9995 |
|
89 |
73 |
$0.00 |