| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,126 |
984 |
$44K |
| D0330 |
Panoramic radiographic image |
1,058 |
894 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,191 |
1,035 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
652 |
303 |
$37K |
| D0274 |
Bitewings - four radiographic images |
888 |
775 |
$26K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
149 |
53 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
1,314 |
1,148 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
516 |
440 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
201 |
92 |
$15K |
| D1206 |
Topical application of fluoride varnish |
932 |
798 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
303 |
136 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
516 |
431 |
$13K |
| D1120 |
Prophylaxis - child |
183 |
162 |
$4K |
| D2332 |
|
32 |
12 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
39 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
175 |
120 |
$829.62 |