| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,935 |
4,935 |
$159K |
| D0274 |
Bitewings - four radiographic images |
4,569 |
4,569 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
4,070 |
4,069 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
2,446 |
2,429 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
6,548 |
6,513 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,039 |
773 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,145 |
2,145 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,530 |
4,520 |
$28K |
| D0330 |
Panoramic radiographic image |
984 |
984 |
$28K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
322 |
133 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
425 |
314 |
$12K |
| D9310 |
|
393 |
392 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
1,282 |
1,278 |
$9K |
| D9243 |
|
57 |
55 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
497 |
497 |
$4K |
| D9239 |
|
56 |
54 |
$3K |
| D0270 |
|
409 |
405 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
51 |
38 |
$2K |
| D1120 |
Prophylaxis - child |
64 |
64 |
$2K |
| D0272 |
Bitewings - two radiographic images |
79 |
79 |
$760.69 |