| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,014 |
2,785 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,710 |
1,549 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
2,351 |
2,202 |
$57K |
| D0274 |
Bitewings - four radiographic images |
1,994 |
1,839 |
$55K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,420 |
2,281 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
493 |
337 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
3,316 |
2,929 |
$44K |
| D0330 |
Panoramic radiographic image |
985 |
883 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
407 |
266 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,488 |
1,389 |
$23K |
| D1120 |
Prophylaxis - child |
671 |
619 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
454 |
404 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
91 |
53 |
$9K |
| D1206 |
Topical application of fluoride varnish |
303 |
266 |
$4K |
| D0272 |
Bitewings - two radiographic images |
66 |
63 |
$1K |
| D3120 |
|
20 |
15 |
$0.00 |
| D1330 |
|
68 |
68 |
$0.00 |
| D0350 |
|
36 |
36 |
$0.00 |
| D1999 |
|
807 |
654 |
$0.00 |