| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,472 |
2,319 |
$119K |
| D1354 |
|
1,121 |
176 |
$102K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,405 |
753 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
4,155 |
3,884 |
$95K |
| D1120 |
Prophylaxis - child |
2,275 |
2,125 |
$72K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,133 |
2,915 |
$68K |
| D0274 |
Bitewings - four radiographic images |
1,450 |
1,340 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
641 |
574 |
$36K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
241 |
134 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
573 |
284 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
894 |
819 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
695 |
629 |
$25K |
| D0272 |
Bitewings - two radiographic images |
757 |
696 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
609 |
538 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
51 |
47 |
$811.72 |