| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,211 |
3,063 |
$145K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
583 |
389 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
2,876 |
2,761 |
$69K |
| D0274 |
Bitewings - four radiographic images |
2,122 |
2,024 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
1,101 |
1,034 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
853 |
810 |
$34K |
| D0330 |
Panoramic radiographic image |
587 |
563 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,765 |
1,649 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
159 |
64 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
135 |
103 |
$14K |
| D2750 |
|
17 |
12 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
410 |
403 |
$6K |
| D1120 |
Prophylaxis - child |
57 |
54 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
14 |
$180.30 |