| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,126 |
1,061 |
$40K |
| D0330 |
Panoramic radiographic image |
1,064 |
955 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
842 |
769 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
589 |
179 |
$18K |
| D0274 |
Bitewings - four radiographic images |
959 |
873 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
581 |
501 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
770 |
740 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
182 |
126 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,131 |
983 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
118 |
76 |
$5K |
| D1120 |
Prophylaxis - child |
109 |
103 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
753 |
520 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
145 |
137 |
$2K |
| D1206 |
Topical application of fluoride varnish |
51 |
51 |
$702.75 |
| D0272 |
Bitewings - two radiographic images |
14 |
13 |
$214.06 |
| D9986 |
|
69 |
65 |
$48.00 |
| D1999 |
|
286 |
271 |
$0.00 |