| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,008 |
1,940 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
2,370 |
2,296 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,227 |
1,205 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
509 |
317 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
374 |
269 |
$22K |
| D0330 |
Panoramic radiographic image |
460 |
447 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
236 |
94 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
890 |
863 |
$16K |
| D1120 |
Prophylaxis - child |
446 |
434 |
$13K |
| D1351 |
Sealant - per tooth |
414 |
112 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
95 |
79 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
308 |
299 |
$6K |
| D2331 |
|
41 |
27 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
66 |
53 |
$2K |
| D0272 |
Bitewings - two radiographic images |
110 |
108 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
44 |
44 |
$328.00 |