| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,046 |
1,001 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
581 |
247 |
$47K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
650 |
348 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
426 |
408 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
931 |
884 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,076 |
1,034 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
180 |
116 |
$19K |
| D0274 |
Bitewings - four radiographic images |
738 |
713 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,122 |
1,001 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
123 |
78 |
$11K |
| D1206 |
Topical application of fluoride varnish |
469 |
450 |
$11K |
| D1120 |
Prophylaxis - child |
337 |
324 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,383 |
1,304 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
196 |
186 |
$7K |
| D2394 |
|
39 |
29 |
$5K |
| D0330 |
Panoramic radiographic image |
28 |
28 |
$2K |
| D1320 |
|
13 |
12 |
$195.00 |