| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,755 |
1,657 |
$76K |
| D0330 |
Panoramic radiographic image |
734 |
691 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,501 |
1,406 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
579 |
368 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,594 |
1,507 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
568 |
228 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
1,229 |
1,136 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
556 |
531 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
206 |
156 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,066 |
1,914 |
$13K |
| D1206 |
Topical application of fluoride varnish |
543 |
510 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
135 |
90 |
$9K |
| D1120 |
Prophylaxis - child |
301 |
285 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,157 |
978 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
363 |
345 |
$8K |
| D1320 |
|
240 |
225 |
$5K |
| D2335 |
|
17 |
13 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
20 |
20 |
$1K |
| D2394 |
|
16 |
12 |
$865.40 |