| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,403 |
1,375 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
1,912 |
1,855 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
2,431 |
2,309 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
319 |
212 |
$34K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
280 |
144 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,733 |
1,511 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
887 |
826 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,683 |
1,632 |
$27K |
| D0274 |
Bitewings - four radiographic images |
821 |
798 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
180 |
130 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
523 |
512 |
$23K |
| D0330 |
Panoramic radiographic image |
378 |
368 |
$21K |
| D0240 |
|
1,217 |
594 |
$19K |
| D1120 |
Prophylaxis - child |
379 |
364 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
38 |
26 |
$3K |
| D2394 |
|
17 |
12 |
$3K |
| D0272 |
Bitewings - two radiographic images |
42 |
42 |
$839.86 |