| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
488 |
468 |
$20K |
| D0330 |
Panoramic radiographic image |
490 |
452 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
762 |
715 |
$18K |
| D0274 |
Bitewings - four radiographic images |
517 |
493 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
474 |
427 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
154 |
108 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,146 |
990 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
198 |
112 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
74 |
53 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
209 |
200 |
$3K |
| D1120 |
Prophylaxis - child |
43 |
41 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
31 |
12 |
$1K |
| D2394 |
|
15 |
12 |
$997.16 |
| D0120 |
Periodic oral evaluation - established patient |
32 |
28 |
$580.35 |
| D0230 |
Intraoral - periapical each additional radiographic image |
26 |
16 |
$55.62 |
| D1999 |
|
197 |
160 |
$0.00 |