| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,024 |
2,875 |
$112K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,062 |
675 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
948 |
891 |
$61K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
651 |
419 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
2,235 |
2,106 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,326 |
1,280 |
$38K |
| D0274 |
Bitewings - four radiographic images |
764 |
729 |
$16K |
| D2394 |
|
204 |
146 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
262 |
181 |
$15K |
| D1120 |
Prophylaxis - child |
387 |
380 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
336 |
318 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
73 |
26 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
293 |
292 |
$5K |
| D0330 |
Panoramic radiographic image |
112 |
108 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
548 |
530 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
58 |
58 |
$1K |
| D2140 |
|
17 |
13 |
$680.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
78 |
66 |
$334.75 |