| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,309 |
5,302 |
$180K |
| D0120 |
Periodic oral evaluation - established patient |
7,098 |
7,089 |
$144K |
| D0274 |
Bitewings - four radiographic images |
5,048 |
5,046 |
$94K |
| D0220 |
Intraoral - periapical first radiographic image |
8,373 |
8,271 |
$79K |
| D1120 |
Prophylaxis - child |
2,307 |
2,301 |
$70K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,657 |
6,645 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,698 |
3,693 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
828 |
533 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
511 |
371 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
2,560 |
2,486 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
636 |
461 |
$25K |
| D0272 |
Bitewings - two radiographic images |
954 |
954 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
2,101 |
2,082 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
506 |
506 |
$10K |
| D4341 |
|
107 |
39 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
67 |
47 |
$4K |
| D9310 |
|
39 |
39 |
$2K |
| D1320 |
|
153 |
153 |
$1K |
| D0330 |
Panoramic radiographic image |
25 |
25 |
$599.33 |
| D1999 |
|
108 |
107 |
$0.00 |
| D0190 |
|
88 |
88 |
$0.00 |
| D1330 |
|
117 |
117 |
$0.00 |