| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,642 |
1,637 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
2,254 |
2,249 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
834 |
540 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
516 |
409 |
$29K |
| D1120 |
Prophylaxis - child |
654 |
654 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
278 |
135 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
892 |
892 |
$17K |
| D0272 |
Bitewings - two radiographic images |
809 |
806 |
$12K |
| D2330 |
|
167 |
124 |
$8K |
| D2332 |
|
81 |
62 |
$5K |
| D9110 |
|
151 |
149 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
57 |
55 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
112 |
112 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
114 |
113 |
$859.05 |
| D0330 |
Panoramic radiographic image |
24 |
24 |
$774.45 |
| D2331 |
|
14 |
12 |
$667.20 |
| D1999 |
|
13 |
12 |
$42.00 |