| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,002 |
999 |
$88K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
970 |
968 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
509 |
507 |
$43K |
| D9430 |
|
1,218 |
1,135 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,273 |
1,270 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
405 |
405 |
$19K |
| D0330 |
Panoramic radiographic image |
324 |
320 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,691 |
775 |
$7K |
| D1120 |
Prophylaxis - child |
113 |
113 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
41 |
26 |
$5K |
| D0274 |
Bitewings - four radiographic images |
231 |
231 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
66 |
48 |
$4K |
| D4910 |
|
42 |
42 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
143 |
138 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
95 |
95 |
$1K |
| D0270 |
|
12 |
12 |
$60.00 |