| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,729 |
1,492 |
$65K |
| D0274 |
Bitewings - four radiographic images |
1,103 |
975 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,257 |
1,093 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
566 |
479 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,334 |
1,116 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
377 |
330 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
489 |
437 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
54 |
28 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
958 |
671 |
$8K |
| D1120 |
Prophylaxis - child |
313 |
288 |
$8K |
| D1351 |
Sealant - per tooth |
274 |
42 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
168 |
112 |
$5K |
| D1206 |
Topical application of fluoride varnish |
108 |
99 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
31 |
14 |
$1K |
| D0330 |
Panoramic radiographic image |
28 |
27 |
$1K |
| D1999 |
|
683 |
557 |
$0.00 |