| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,272 |
6,090 |
$72K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,154 |
2,030 |
$65K |
| D2750 |
|
223 |
167 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,482 |
1,504 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
6,000 |
5,864 |
$41K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,320 |
959 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,666 |
2,611 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
1,776 |
1,685 |
$18K |
| D0274 |
Bitewings - four radiographic images |
4,404 |
4,284 |
$17K |
| D0330 |
Panoramic radiographic image |
1,444 |
1,417 |
$16K |
| D1120 |
Prophylaxis - child |
1,580 |
1,565 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,791 |
1,776 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,552 |
1,427 |
$3K |
| D9110 |
|
187 |
180 |
$2K |
| D2954 |
|
34 |
29 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
252 |
237 |
$772.75 |
| D0210 |
Intraoral - complete series of radiographic images |
110 |
101 |
$720.00 |
| D2332 |
|
37 |
26 |
$647.50 |
| D2331 |
|
18 |
12 |
$447.50 |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
12 |
$410.00 |
| D0601 |
|
12 |
12 |
$0.00 |