| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
745 |
718 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
725 |
700 |
$24K |
| D0330 |
Panoramic radiographic image |
309 |
289 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
395 |
378 |
$16K |
| D0274 |
Bitewings - four radiographic images |
531 |
518 |
$16K |
| D1120 |
Prophylaxis - child |
214 |
212 |
$10K |
| D1206 |
Topical application of fluoride varnish |
412 |
405 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
102 |
89 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
252 |
243 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
84 |
57 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
841 |
362 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
648 |
612 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
86 |
69 |
$6K |
| T1015 |
Clinic visit/encounter, all-inclusive |
70 |
66 |
$727.08 |