| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,380 |
1,222 |
$54K |
| D0210 |
Intraoral - complete series of radiographic images |
668 |
528 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,824 |
1,628 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
510 |
216 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,305 |
1,194 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
942 |
793 |
$25K |
| D0274 |
Bitewings - four radiographic images |
803 |
714 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,488 |
1,344 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
285 |
101 |
$13K |
| D1120 |
Prophylaxis - child |
357 |
339 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,368 |
1,019 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
215 |
27 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
27 |
15 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
62 |
61 |
$2K |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$541.62 |
| D1330 |
|
162 |
84 |
$0.00 |