| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,357 |
2,203 |
$113K |
| D0120 |
Periodic oral evaluation - established patient |
2,617 |
2,474 |
$60K |
| D0330 |
Panoramic radiographic image |
652 |
592 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
547 |
489 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
419 |
368 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
213 |
145 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
164 |
68 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
611 |
595 |
$11K |
| D0274 |
Bitewings - four radiographic images |
270 |
265 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
720 |
647 |
$9K |
| D1120 |
Prophylaxis - child |
185 |
185 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
15 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17 |
12 |
$209.00 |
| D0190 |
|
17 |
16 |
$0.00 |