| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4355 |
|
1,061 |
1,035 |
$71K |
| D0140 |
Limited oral evaluation - problem focused |
1,319 |
1,292 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
1,782 |
1,751 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,358 |
1,313 |
$43K |
| D1110 |
Prophylaxis - adult |
1,082 |
1,065 |
$41K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
247 |
91 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
552 |
532 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,571 |
1,498 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,110 |
1,080 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
208 |
206 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
120 |
85 |
$12K |
| D0170 |
|
253 |
236 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
408 |
247 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
64 |
64 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
25 |
25 |
$462.63 |