| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,286 |
1,199 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,974 |
1,842 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,413 |
1,333 |
$35K |
| D0330 |
Panoramic radiographic image |
442 |
431 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,818 |
1,690 |
$15K |
| D1120 |
Prophylaxis - child |
363 |
315 |
$14K |
| D9110 |
|
240 |
232 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
288 |
268 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
927 |
451 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
115 |
92 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
56 |
50 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
193 |
160 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
37 |
25 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
90 |
67 |
$834.35 |
| D9215 |
|
104 |
94 |
$280.80 |
| D1999 |
|
447 |
385 |
$0.00 |
| D0603 |
|
59 |
37 |
$0.00 |
| D1330 |
|
60 |
37 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
48 |
31 |
$0.00 |