| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,755 |
5,754 |
$209K |
| D2750 |
|
262 |
204 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
4,673 |
4,669 |
$93K |
| D0274 |
Bitewings - four radiographic images |
4,057 |
4,055 |
$78K |
| D0210 |
Intraoral - complete series of radiographic images |
1,982 |
1,980 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
6,117 |
6,071 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,423 |
2,423 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
801 |
594 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,482 |
4,468 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
2,203 |
2,187 |
$22K |
| D1120 |
Prophylaxis - child |
669 |
669 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
347 |
225 |
$13K |
| D2952 |
|
82 |
70 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
590 |
590 |
$7K |
| D0270 |
|
699 |
699 |
$6K |
| D0330 |
Panoramic radiographic image |
159 |
159 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
32 |
14 |
$2K |
| D0272 |
Bitewings - two radiographic images |
138 |
138 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
16 |
$2K |