| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,452 |
2,397 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
3,147 |
3,092 |
$53K |
| D0274 |
Bitewings - four radiographic images |
2,154 |
2,101 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
616 |
309 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,820 |
1,796 |
$27K |
| D1120 |
Prophylaxis - child |
1,313 |
1,295 |
$26K |
| D2335 |
|
236 |
82 |
$20K |
| D1354 |
|
1,319 |
334 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
652 |
631 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
258 |
114 |
$16K |
| D2332 |
|
200 |
67 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
473 |
455 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,659 |
1,556 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
158 |
79 |
$8K |
| D0272 |
Bitewings - two radiographic images |
725 |
714 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
84 |
54 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,088 |
477 |
$5K |
| D0240 |
|
419 |
184 |
$4K |
| D0330 |
Panoramic radiographic image |
14 |
13 |
$602.16 |