| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,233 |
4,062 |
$156K |
| D0120 |
Periodic oral evaluation - established patient |
4,336 |
4,133 |
$101K |
| D0274 |
Bitewings - four radiographic images |
2,374 |
2,250 |
$71K |
| D0330 |
Panoramic radiographic image |
753 |
719 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
504 |
487 |
$21K |
| D1206 |
Topical application of fluoride varnish |
1,248 |
1,211 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,434 |
1,304 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
170 |
107 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
458 |
428 |
$16K |
| D1120 |
Prophylaxis - child |
390 |
377 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
764 |
567 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
54 |
40 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
57 |
36 |
$4K |
| D2332 |
|
20 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
43 |
41 |
$754.26 |
| D0431 |
|
18 |
18 |
$0.00 |