| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9110 |
|
991 |
871 |
$54K |
| D1120 |
Prophylaxis - child |
1,058 |
1,040 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,061 |
1,050 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
942 |
922 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,088 |
1,043 |
$24K |
| D1110 |
Prophylaxis - adult |
432 |
425 |
$18K |
| D0274 |
Bitewings - four radiographic images |
713 |
700 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
646 |
603 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
140 |
90 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,600 |
1,487 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
145 |
118 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
247 |
228 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
305 |
305 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
13 |
$754.65 |
| D0330 |
Panoramic radiographic image |
14 |
13 |
$218.60 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$133.08 |
| D1999 |
|
58 |
42 |
$0.00 |