| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,077 |
1,076 |
$39K |
| D0330 |
Panoramic radiographic image |
888 |
887 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
452 |
310 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
477 |
297 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,087 |
1,083 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
789 |
787 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,056 |
1,052 |
$17K |
| D1120 |
Prophylaxis - child |
478 |
477 |
$16K |
| D1330 |
|
910 |
906 |
$10K |
| D1310 |
|
908 |
904 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
434 |
433 |
$9K |
| D4346 |
|
186 |
186 |
$8K |
| D2330 |
|
133 |
79 |
$7K |
| D2332 |
|
99 |
70 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
91 |
77 |
$5K |
| D2331 |
|
93 |
60 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
73 |
71 |
$4K |
| D1206 |
Topical application of fluoride varnish |
209 |
208 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
52 |
24 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
319 |
315 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
34 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
40 |
40 |
$424.00 |