| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,264 |
1,113 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
896 |
782 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
616 |
571 |
$12K |
| D0330 |
Panoramic radiographic image |
328 |
288 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,683 |
1,470 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
264 |
192 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
355 |
195 |
$11K |
| D0274 |
Bitewings - four radiographic images |
432 |
394 |
$10K |
| D1120 |
Prophylaxis - child |
256 |
237 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
688 |
594 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
217 |
144 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
238 |
219 |
$6K |
| D2330 |
|
40 |
24 |
$1K |
| D2331 |
|
17 |
12 |
$899.25 |
| D0210 |
Intraoral - complete series of radiographic images |
18 |
14 |
$735.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
17 |
12 |
$87.96 |