| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,998 |
2,991 |
$130K |
| D0120 |
Periodic oral evaluation - established patient |
4,229 |
4,214 |
$93K |
| D0274 |
Bitewings - four radiographic images |
2,489 |
2,484 |
$55K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,874 |
2,850 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
2,265 |
2,251 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,332 |
2,316 |
$23K |
| D1120 |
Prophylaxis - child |
435 |
435 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
187 |
160 |
$13K |
| D0330 |
Panoramic radiographic image |
214 |
213 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
127 |
108 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
114 |
78 |
$6K |
| D1206 |
Topical application of fluoride varnish |
165 |
165 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
402 |
402 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
43 |
38 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
150 |
145 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$330.00 |
| D9110 |
|
14 |
14 |
$278.59 |