| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,640 |
2,487 |
$72K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,124 |
730 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
1,098 |
1,009 |
$49K |
| D1206 |
Topical application of fluoride varnish |
2,167 |
2,014 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
450 |
273 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
969 |
896 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
402 |
167 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
841 |
767 |
$16K |
| D0274 |
Bitewings - four radiographic images |
774 |
744 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
824 |
781 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,179 |
1,077 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
44 |
37 |
$4K |
| D2331 |
|
40 |
27 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
182 |
180 |
$2K |
| D0160 |
|
30 |
28 |
$1K |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$590.03 |
| D0230 |
Intraoral - periapical each additional radiographic image |
78 |
37 |
$358.25 |
| D1330 |
|
27 |
25 |
$0.00 |