| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,009 |
994 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
588 |
572 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
451 |
332 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
808 |
786 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
944 |
932 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
432 |
221 |
$15K |
| D0274 |
Bitewings - four radiographic images |
410 |
395 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
369 |
356 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
192 |
140 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,052 |
1,003 |
$8K |
| D1206 |
Topical application of fluoride varnish |
478 |
477 |
$6K |
| D1120 |
Prophylaxis - child |
105 |
105 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
462 |
304 |
$2K |
| D2331 |
|
43 |
30 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
34 |
30 |
$2K |
| D0330 |
Panoramic radiographic image |
18 |
18 |
$1K |