| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,305 |
2,227 |
$91K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,619 |
2,547 |
$66K |
| D0330 |
Panoramic radiographic image |
1,484 |
1,446 |
$54K |
| D0274 |
Bitewings - four radiographic images |
2,082 |
2,018 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,273 |
1,239 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
336 |
288 |
$17K |
| D1120 |
Prophylaxis - child |
349 |
341 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
364 |
226 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
247 |
186 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
523 |
492 |
$8K |
| D2331 |
|
20 |
12 |
$784.52 |
| D0140 |
Limited oral evaluation - problem focused |
29 |
26 |
$716.10 |
| D0272 |
Bitewings - two radiographic images |
50 |
49 |
$692.97 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
13 |
$653.22 |
| D9996 |
|
13 |
13 |
$43.50 |
| D1999 |
|
607 |
534 |
$0.00 |