| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,640 |
1,637 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,081 |
1,075 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,446 |
1,439 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
896 |
892 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
329 |
328 |
$14K |
| D0330 |
Panoramic radiographic image |
292 |
290 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
166 |
123 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,170 |
1,125 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
512 |
504 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
180 |
178 |
$3K |
| D0601 |
|
304 |
303 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
41 |
25 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
23 |
12 |
$1K |
| D1120 |
Prophylaxis - child |
42 |
41 |
$916.27 |
| D1330 |
|
73 |
72 |
$374.32 |
| D9110 |
|
12 |
12 |
$340.20 |
| D1310 |
|
60 |
59 |
$308.48 |