| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,904 |
1,858 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
2,011 |
1,971 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
640 |
443 |
$34K |
| D0330 |
Panoramic radiographic image |
713 |
694 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,099 |
1,083 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
554 |
374 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
895 |
881 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
819 |
814 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
321 |
194 |
$15K |
| D1120 |
Prophylaxis - child |
522 |
521 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
977 |
953 |
$8K |
| D9110 |
|
295 |
290 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
235 |
211 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
28 |
25 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
37 |
34 |
$1K |
| D0272 |
Bitewings - two radiographic images |
38 |
38 |
$666.80 |
| D1330 |
|
75 |
75 |
$320.00 |
| D0431 |
|
294 |
293 |
$0.00 |