| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,288 |
2,051 |
$81K |
| D0330 |
Panoramic radiographic image |
2,129 |
1,897 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,189 |
1,955 |
$53K |
| D0274 |
Bitewings - four radiographic images |
2,592 |
2,339 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
974 |
906 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
3,342 |
2,792 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
270 |
161 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,110 |
2,364 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
173 |
78 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
98 |
51 |
$3K |
| D1120 |
Prophylaxis - child |
47 |
45 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
33 |
25 |
$2K |
| D1206 |
Topical application of fluoride varnish |
122 |
121 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
53 |
51 |
$1K |
| D9986 |
|
16 |
14 |
$0.00 |