| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,200 |
3,200 |
$232K |
| D0120 |
Periodic oral evaluation - established patient |
4,877 |
4,877 |
$176K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,574 |
667 |
$164K |
| D0274 |
Bitewings - four radiographic images |
3,931 |
3,931 |
$153K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
854 |
470 |
$113K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,587 |
561 |
$109K |
| D0330 |
Panoramic radiographic image |
2,028 |
2,027 |
$101K |
| D0220 |
Intraoral - periapical first radiographic image |
3,812 |
3,554 |
$62K |
| D1206 |
Topical application of fluoride varnish |
1,547 |
1,547 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
2,544 |
2,359 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,531 |
2,531 |
$44K |
| D1120 |
Prophylaxis - child |
804 |
804 |
$43K |
| D2394 |
|
209 |
121 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,983 |
2,954 |
$28K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
68 |
30 |
$8K |
| D9110 |
|
109 |
109 |
$4K |
| D0272 |
Bitewings - two radiographic images |
186 |
186 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
59 |
59 |
$3K |