| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,968 |
1,930 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
2,320 |
2,274 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,123 |
3,063 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
774 |
484 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
1,148 |
1,108 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
428 |
261 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
676 |
388 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,250 |
1,238 |
$28K |
| D1120 |
Prophylaxis - child |
668 |
650 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
492 |
483 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,416 |
1,297 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
231 |
226 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
52 |
41 |
$4K |
| D1999 |
|
517 |
432 |
$3K |
| D4910 |
|
39 |
39 |
$3K |
| D2332 |
|
29 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
101 |
98 |
$1K |
| D0272 |
Bitewings - two radiographic images |
70 |
69 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
55 |
51 |
$441.00 |