| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,506 |
1,386 |
$67K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,074 |
1,763 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
422 |
219 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,370 |
1,283 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
4,169 |
2,732 |
$35K |
| D0330 |
Panoramic radiographic image |
840 |
621 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,566 |
1,000 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
1,129 |
834 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
194 |
91 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
528 |
517 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
579 |
528 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
158 |
50 |
$10K |
| D2950 |
|
14 |
13 |
$2K |
| D1120 |
Prophylaxis - child |
26 |
26 |
$992.24 |
| D9630 |
|
49 |
36 |
$715.32 |