| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4355 |
|
821 |
766 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
1,278 |
1,189 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,779 |
1,677 |
$42K |
| D1110 |
Prophylaxis - adult |
1,126 |
1,076 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,086 |
1,005 |
$32K |
| D0330 |
Panoramic radiographic image |
531 |
491 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,275 |
1,162 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
899 |
425 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
855 |
802 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
119 |
107 |
$4K |
| D4341 |
|
54 |
12 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
24 |
13 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
43 |
13 |
$3K |
| D1120 |
Prophylaxis - child |
88 |
82 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
27 |
$2K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$211.08 |