| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,815 |
1,768 |
$112K |
| D0120 |
Periodic oral evaluation - established patient |
1,914 |
1,828 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
850 |
833 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,496 |
1,450 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
559 |
559 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
204 |
152 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,746 |
2,640 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
200 |
104 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
621 |
583 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,929 |
1,864 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
78 |
56 |
$8K |
| D0330 |
Panoramic radiographic image |
159 |
159 |
$7K |
| D1120 |
Prophylaxis - child |
151 |
148 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
44 |
25 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$3K |
| D2950 |
|
15 |
13 |
$1K |