| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
570 |
490 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
577 |
482 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
468 |
395 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,105 |
848 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
131 |
55 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
168 |
141 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
349 |
314 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
696 |
356 |
$6K |
| D0274 |
Bitewings - four radiographic images |
208 |
166 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
41 |
17 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
21 |
12 |
$2K |
| D0270 |
|
120 |
99 |
$849.99 |
| D1206 |
Topical application of fluoride varnish |
53 |
41 |
$553.74 |
| D0330 |
Panoramic radiographic image |
17 |
13 |
$517.40 |
| D1208 |
Topical application of fluoride, excluding varnish |
17 |
13 |
$138.32 |
| D0350 |
|
94 |
79 |
$0.00 |