| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,312 |
2,204 |
$115K |
| D0274 |
Bitewings - four radiographic images |
2,091 |
1,988 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,028 |
980 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,594 |
1,523 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,223 |
1,985 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
690 |
643 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,748 |
1,314 |
$19K |
| D0330 |
Panoramic radiographic image |
447 |
439 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
82 |
41 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
196 |
181 |
$5K |
| D1351 |
Sealant - per tooth |
153 |
24 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
22 |
12 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
50 |
26 |
$3K |
| D1120 |
Prophylaxis - child |
58 |
54 |
$2K |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$336.00 |