| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,909 |
2,732 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
2,833 |
2,654 |
$66K |
| D0274 |
Bitewings - four radiographic images |
1,095 |
1,029 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
291 |
203 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
637 |
572 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
636 |
558 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
145 |
122 |
$18K |
| D2335 |
|
105 |
51 |
$12K |
| D0330 |
Panoramic radiographic image |
234 |
220 |
$12K |
| D1120 |
Prophylaxis - child |
358 |
311 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
79 |
61 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
424 |
369 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
81 |
67 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
313 |
275 |
$4K |
| D1206 |
Topical application of fluoride varnish |
281 |
255 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
47 |
15 |
$3K |
| D2140 |
|
47 |
27 |
$3K |
| D2332 |
|
18 |
14 |
$2K |
| D4355 |
|
28 |
26 |
$2K |
| D0272 |
Bitewings - two radiographic images |
36 |
31 |
$542.29 |
| D0230 |
Intraoral - periapical each additional radiographic image |
42 |
14 |
$449.46 |