| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,090 |
1,035 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
542 |
271 |
$38K |
| D1206 |
Topical application of fluoride varnish |
1,423 |
1,361 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,216 |
1,160 |
$28K |
| D1120 |
Prophylaxis - child |
515 |
501 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
288 |
283 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
280 |
169 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
542 |
527 |
$16K |
| D0330 |
Panoramic radiographic image |
230 |
219 |
$10K |
| D0274 |
Bitewings - four radiographic images |
266 |
254 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
71 |
45 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
70 |
14 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
34 |
14 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
117 |
108 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
108 |
59 |
$869.55 |
| D1208 |
Topical application of fluoride, excluding varnish |
39 |
37 |
$781.05 |
| D0272 |
Bitewings - two radiographic images |
30 |
29 |
$506.28 |
| D2950 |
|
16 |
13 |
$398.01 |