| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,113 |
2,094 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
999 |
578 |
$57K |
| D0274 |
Bitewings - four radiographic images |
1,892 |
1,874 |
$47K |
| D7140 |
Extraction, erupted tooth or exposed root |
759 |
392 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
581 |
301 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,398 |
1,383 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,008 |
998 |
$19K |
| D0330 |
Panoramic radiographic image |
475 |
467 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
250 |
178 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
222 |
221 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
875 |
857 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
678 |
649 |
$5K |
| D2335 |
|
59 |
40 |
$4K |
| D1206 |
Topical application of fluoride varnish |
188 |
186 |
$3K |
| D1351 |
Sealant - per tooth |
77 |
14 |
$2K |
| D1120 |
Prophylaxis - child |
40 |
40 |
$978.96 |
| D0140 |
Limited oral evaluation - problem focused |
25 |
25 |
$488.44 |