| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,885 |
3,873 |
$139K |
| D0120 |
Periodic oral evaluation - established patient |
4,580 |
4,574 |
$89K |
| D0274 |
Bitewings - four radiographic images |
3,788 |
3,787 |
$70K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
859 |
644 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
5,478 |
5,373 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,378 |
4,369 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
836 |
589 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
660 |
470 |
$25K |
| D1120 |
Prophylaxis - child |
813 |
813 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
2,293 |
2,170 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,018 |
2,017 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
282 |
281 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
90 |
87 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
967 |
961 |
$4K |
| D0272 |
Bitewings - two radiographic images |
332 |
332 |
$4K |
| D2954 |
|
33 |
30 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$821.00 |
| D0330 |
Panoramic radiographic image |
29 |
29 |
$520.98 |
| D1320 |
|
52 |
52 |
$416.00 |
| D9310 |
|
14 |
14 |
$285.98 |
| D1999 |
|
15 |
15 |
$0.00 |
| D0190 |
|
13 |
13 |
$0.00 |