| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
924 |
917 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,232 |
1,226 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
379 |
139 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
336 |
323 |
$14K |
| D0274 |
Bitewings - four radiographic images |
926 |
917 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
527 |
517 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
443 |
434 |
$11K |
| D4910 |
|
157 |
156 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
841 |
813 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
112 |
89 |
$7K |
| D0330 |
Panoramic radiographic image |
498 |
484 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
93 |
75 |
$5K |
| D1206 |
Topical application of fluoride varnish |
224 |
221 |
$4K |
| D1120 |
Prophylaxis - child |
110 |
108 |
$3K |
| D4355 |
|
14 |
14 |
$562.87 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$119.95 |