| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,827 |
1,825 |
$55K |
| D0210 |
Intraoral - complete series of radiographic images |
551 |
551 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
1,196 |
1,196 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
866 |
866 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,367 |
1,336 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
457 |
446 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
116 |
71 |
$6K |
| D0274 |
Bitewings - four radiographic images |
400 |
400 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
333 |
333 |
$5K |
| D1320 |
|
526 |
524 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
741 |
740 |
$3K |
| D9110 |
|
121 |
120 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
12 |
$560.00 |