| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9110 |
|
1,443 |
1,350 |
$78K |
| D1120 |
Prophylaxis - child |
1,859 |
1,709 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
2,137 |
1,976 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,751 |
1,603 |
$42K |
| D0330 |
Panoramic radiographic image |
988 |
945 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
267 |
163 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
258 |
207 |
$15K |
| D1110 |
Prophylaxis - adult |
214 |
214 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
311 |
309 |
$8K |
| D0274 |
Bitewings - four radiographic images |
366 |
358 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
97 |
81 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
37 |
25 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
276 |
271 |
$2K |
| D1351 |
Sealant - per tooth |
24 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
75 |
75 |
$353.92 |