| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,143 |
1,133 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
406 |
235 |
$24K |
| D0274 |
Bitewings - four radiographic images |
783 |
776 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
973 |
963 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
196 |
138 |
$13K |
| D0330 |
Panoramic radiographic image |
310 |
306 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
490 |
484 |
$9K |
| D9110 |
|
268 |
259 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
946 |
891 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
124 |
68 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
438 |
425 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
216 |
196 |
$4K |
| D1206 |
Topical application of fluoride varnish |
118 |
118 |
$2K |
| D1330 |
|
318 |
317 |
$2K |
| D1310 |
|
318 |
317 |
$2K |
| D4910 |
|
43 |
41 |
$2K |
| D1320 |
|
101 |
91 |
$1K |
| D1120 |
Prophylaxis - child |
58 |
58 |
$1K |
| D0601 |
|
122 |
122 |
$1K |
| D0603 |
|
55 |
55 |
$530.00 |