| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,388 |
1,380 |
$75K |
| D0330 |
Panoramic radiographic image |
578 |
577 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
785 |
781 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
315 |
219 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,262 |
1,255 |
$32K |
| D0274 |
Bitewings - four radiographic images |
554 |
551 |
$22K |
| D2332 |
|
145 |
94 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
182 |
151 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
354 |
347 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
1,053 |
688 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
69 |
52 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
744 |
708 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
371 |
369 |
$7K |
| D0277 |
|
188 |
187 |
$6K |
| D1120 |
Prophylaxis - child |
167 |
166 |
$6K |
| D1351 |
Sealant - per tooth |
166 |
27 |
$5K |
| D1206 |
Topical application of fluoride varnish |
174 |
170 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
13 |
$2K |
| D4346 |
|
14 |
14 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
61 |
46 |
$700.00 |