| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,398 |
4,298 |
$144K |
| D0120 |
Periodic oral evaluation - established patient |
6,638 |
6,486 |
$108K |
| D0330 |
Panoramic radiographic image |
1,848 |
1,758 |
$79K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,178 |
629 |
$64K |
| D1206 |
Topical application of fluoride varnish |
4,153 |
4,052 |
$59K |
| D1120 |
Prophylaxis - child |
2,948 |
2,857 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
656 |
409 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
673 |
411 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,661 |
1,617 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
846 |
810 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
952 |
921 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,023 |
1,005 |
$10K |
| D2331 |
|
118 |
58 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
77 |
61 |
$5K |
| D2332 |
|
64 |
37 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
624 |
583 |
$3K |
| D2335 |
|
20 |
12 |
$2K |
| D1351 |
Sealant - per tooth |
79 |
16 |
$2K |
| D2330 |
|
20 |
14 |
$921.78 |