| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
773 |
758 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
849 |
808 |
$22K |
| D1120 |
Prophylaxis - child |
1,081 |
1,058 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,393 |
1,352 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
1,148 |
1,074 |
$19K |
| D0274 |
Bitewings - four radiographic images |
321 |
311 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
102 |
64 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
829 |
773 |
$4K |
| D0272 |
Bitewings - two radiographic images |
414 |
402 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
173 |
168 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
46 |
36 |
$2K |
| D0330 |
Panoramic radiographic image |
39 |
39 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
37 |
25 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
252 |
216 |
$1K |
| T1015 |
Clinic visit/encounter, all-inclusive |
211 |
186 |
$0.00 |