| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,624 |
4,622 |
$178K |
| D0120 |
Periodic oral evaluation - established patient |
6,206 |
6,203 |
$124K |
| D0274 |
Bitewings - four radiographic images |
4,826 |
4,824 |
$96K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,676 |
1,073 |
$94K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,256 |
792 |
$49K |
| D1120 |
Prophylaxis - child |
1,446 |
1,446 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,503 |
4,499 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
1,028 |
1,028 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,448 |
2,448 |
$24K |
| D4341 |
|
441 |
129 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
251 |
168 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
841 |
841 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
61 |
61 |
$1K |
| D2330 |
|
23 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$136.00 |