| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
590 |
578 |
$29K |
| D0330 |
Panoramic radiographic image |
547 |
535 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
547 |
534 |
$15K |
| D4341 |
|
153 |
53 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
406 |
393 |
$10K |
| D0274 |
Bitewings - four radiographic images |
375 |
369 |
$9K |
| D4910 |
|
111 |
106 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
94 |
45 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
152 |
142 |
$5K |
| D1120 |
Prophylaxis - child |
68 |
67 |
$4K |
| D4342 |
|
71 |
25 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
198 |
195 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
87 |
83 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
13 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
16 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
277 |
268 |
$1K |
| D2950 |
|
14 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
387 |
147 |
$376.56 |
| D0272 |
Bitewings - two radiographic images |
18 |
17 |
$318.50 |
| D9986 |
|
91 |
84 |
$246.00 |
| D9987 |
|
14 |
12 |
$42.00 |