| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,645 |
2,559 |
$112K |
| D0330 |
Panoramic radiographic image |
2,100 |
2,035 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,695 |
2,602 |
$72K |
| D0274 |
Bitewings - four radiographic images |
2,785 |
2,700 |
$64K |
| D0140 |
Limited oral evaluation - problem focused |
1,974 |
1,831 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,488 |
1,439 |
$22K |
| D1120 |
Prophylaxis - child |
418 |
396 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,424 |
2,035 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
581 |
563 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
82 |
57 |
$4K |
| D2394 |
|
61 |
39 |
$4K |
| D0272 |
Bitewings - two radiographic images |
164 |
159 |
$3K |
| D1351 |
Sealant - per tooth |
171 |
30 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
18 |
16 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
14 |
$1K |
| D9986 |
|
14 |
12 |
$0.00 |