| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,006 |
1,909 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
2,101 |
2,019 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
645 |
396 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
374 |
267 |
$34K |
| D0274 |
Bitewings - four radiographic images |
971 |
921 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
294 |
264 |
$10K |
| D0330 |
Panoramic radiographic image |
135 |
127 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
165 |
157 |
$6K |
| D2330 |
|
88 |
65 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
272 |
260 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
206 |
195 |
$3K |
| D2331 |
|
37 |
28 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
32 |
24 |
$2K |
| D1120 |
Prophylaxis - child |
19 |
19 |
$465.66 |
| D0230 |
Intraoral - periapical each additional radiographic image |
37 |
25 |
$423.28 |
| D0272 |
Bitewings - two radiographic images |
25 |
24 |
$383.98 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$183.00 |