| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
764 |
726 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
649 |
615 |
$17K |
| D0274 |
Bitewings - four radiographic images |
816 |
780 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
670 |
616 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
239 |
71 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,280 |
1,095 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
204 |
111 |
$10K |
| D0330 |
Panoramic radiographic image |
221 |
213 |
$10K |
| D2161 |
|
107 |
60 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,570 |
1,455 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
441 |
423 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
95 |
42 |
$5K |
| D2335 |
|
49 |
24 |
$5K |
| D1320 |
|
229 |
223 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
212 |
202 |
$3K |
| D1120 |
Prophylaxis - child |
148 |
142 |
$3K |
| D1321 |
|
192 |
186 |
$3K |
| D2394 |
|
34 |
15 |
$3K |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$140.00 |