| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,627 |
1,554 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
1,789 |
1,707 |
$43K |
| D0274 |
Bitewings - four radiographic images |
933 |
895 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
356 |
272 |
$29K |
| D0330 |
Panoramic radiographic image |
418 |
407 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
231 |
102 |
$18K |
| D1206 |
Topical application of fluoride varnish |
817 |
789 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
414 |
407 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
388 |
376 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
145 |
117 |
$9K |
| D1120 |
Prophylaxis - child |
195 |
190 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
54 |
51 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
361 |
336 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
15 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22 |
12 |
$268.00 |