| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,704 |
2,677 |
$118K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
872 |
358 |
$72K |
| D1120 |
Prophylaxis - child |
1,627 |
1,609 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
3,458 |
3,414 |
$58K |
| D0330 |
Panoramic radiographic image |
975 |
968 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
987 |
980 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
599 |
246 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,880 |
3,839 |
$14K |
| D0274 |
Bitewings - four radiographic images |
3,110 |
3,074 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
83 |
45 |
$7K |
| D1330 |
|
3,937 |
3,895 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
3,700 |
3,657 |
$3K |
| D0272 |
Bitewings - two radiographic images |
233 |
230 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,681 |
3,631 |
$1K |
| D1999 |
|
194 |
194 |
$845.53 |
| D7111 |
|
20 |
13 |
$695.60 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
55 |
20 |
$374.40 |
| D0601 |
|
12 |
12 |
$0.00 |