| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
2,279 |
2,088 |
$65K |
| D1110 |
Prophylaxis - adult |
1,626 |
1,547 |
$58K |
| D0330 |
Panoramic radiographic image |
1,630 |
1,536 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,064 |
736 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,905 |
1,815 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,744 |
1,644 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
605 |
456 |
$34K |
| D1120 |
Prophylaxis - child |
768 |
748 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,079 |
1,040 |
$22K |
| D1206 |
Topical application of fluoride varnish |
1,266 |
1,231 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
454 |
330 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,358 |
2,182 |
$16K |
| D4341 |
|
157 |
71 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,866 |
924 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
185 |
160 |
$7K |
| D0272 |
Bitewings - two radiographic images |
96 |
95 |
$2K |
| D2332 |
|
27 |
15 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
107 |
94 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
12 |
$629.78 |
| D1999 |
|
107 |
91 |
$0.00 |