| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,003 |
3,000 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
2,857 |
2,857 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
1,103 |
1,103 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
3,300 |
3,265 |
$12K |
| D0274 |
Bitewings - four radiographic images |
1,419 |
1,417 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
719 |
710 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
468 |
275 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
780 |
778 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
199 |
100 |
$8K |
| D2335 |
|
206 |
96 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,586 |
2,585 |
$7K |
| D2394 |
|
118 |
91 |
$6K |
| D2330 |
|
84 |
29 |
$2K |
| D1120 |
Prophylaxis - child |
165 |
165 |
$2K |
| D0272 |
Bitewings - two radiographic images |
306 |
306 |
$1K |
| D2332 |
|
46 |
13 |
$1K |
| D4341 |
|
34 |
12 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
33 |
15 |
$840.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
87 |
87 |
$407.00 |
| D0270 |
|
141 |
140 |
$298.25 |