| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,265 |
3,229 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
2,685 |
2,652 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
1,122 |
1,109 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,278 |
1,264 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,774 |
3,659 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
484 |
278 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
4,075 |
3,610 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
244 |
126 |
$6K |
| D0272 |
Bitewings - two radiographic images |
1,646 |
1,605 |
$4K |
| D2335 |
|
166 |
64 |
$4K |
| D0274 |
Bitewings - four radiographic images |
353 |
353 |
$2K |
| D2750 |
|
15 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
142 |
138 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
107 |
103 |
$893.50 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
42 |
26 |
$780.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
12 |
$394.00 |
| D0140 |
Limited oral evaluation - problem focused |
51 |
51 |
$368.00 |
| D1999 |
|
93 |
88 |
$0.00 |