| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
2,659 |
2,659 |
$78K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
819 |
519 |
$57K |
| D1110 |
Prophylaxis - adult |
1,228 |
1,227 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,521 |
1,521 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,819 |
2,819 |
$51K |
| D1120 |
Prophylaxis - child |
1,473 |
1,473 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
1,381 |
1,381 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
558 |
405 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
356 |
143 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
530 |
527 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
658 |
637 |
$7K |
| D0330 |
Panoramic radiographic image |
108 |
108 |
$4K |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$278.93 |