| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D5110 |
|
68 |
61 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
476 |
164 |
$22K |
| D1120 |
Prophylaxis - child |
493 |
463 |
$19K |
| D5120 |
|
42 |
41 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
518 |
484 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
468 |
442 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
554 |
526 |
$11K |
| D0274 |
Bitewings - four radiographic images |
553 |
529 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
174 |
144 |
$9K |
| D1110 |
Prophylaxis - adult |
237 |
210 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
230 |
163 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,068 |
1,007 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,075 |
841 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
179 |
165 |
$3K |
| D0272 |
Bitewings - two radiographic images |
159 |
151 |
$1K |
| D2950 |
|
17 |
12 |
$986.85 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
14 |
$812.70 |
| D0210 |
Intraoral - complete series of radiographic images |
76 |
71 |
$265.80 |