| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
739 |
732 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
992 |
985 |
$23K |
| D0330 |
Panoramic radiographic image |
542 |
528 |
$18K |
| D1120 |
Prophylaxis - child |
436 |
424 |
$18K |
| D0274 |
Bitewings - four radiographic images |
643 |
624 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
536 |
524 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
260 |
247 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
157 |
144 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
74 |
59 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
304 |
288 |
$2K |
| D0272 |
Bitewings - two radiographic images |
97 |
96 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
14 |
$752.70 |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
14 |
$584.86 |
| D9986 |
|
14 |
12 |
$0.00 |