| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,593 |
1,587 |
$58K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
688 |
412 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,621 |
1,614 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,315 |
1,308 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
557 |
556 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
418 |
198 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
381 |
254 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
751 |
750 |
$18K |
| D9110 |
|
438 |
433 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
187 |
130 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,402 |
1,336 |
$11K |
| D0330 |
Panoramic radiographic image |
242 |
241 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
988 |
857 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
223 |
220 |
$4K |
| D2331 |
|
44 |
30 |
$2K |
| D1120 |
Prophylaxis - child |
52 |
52 |
$2K |
| D0601 |
|
147 |
147 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15 |
12 |
$1K |
| D1330 |
|
156 |
156 |
$780.00 |