| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,615 |
3,589 |
$100K |
| D0210 |
Intraoral - complete series of radiographic images |
1,584 |
1,577 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
2,225 |
2,217 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,095 |
2,088 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,579 |
2,985 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,597 |
1,594 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
561 |
267 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
337 |
163 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
3,401 |
3,313 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
480 |
474 |
$11K |
| D1120 |
Prophylaxis - child |
293 |
292 |
$7K |
| D0272 |
Bitewings - two radiographic images |
986 |
985 |
$7K |
| D2750 |
|
17 |
13 |
$4K |
| D0274 |
Bitewings - four radiographic images |
408 |
407 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
30 |
12 |
$2K |
| D2335 |
|
33 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
44 |
28 |
$1K |
| D4341 |
|
40 |
12 |
$1K |
| D0603 |
|
30 |
30 |
$260.00 |
| D1999 |
|
14 |
14 |
$0.00 |