| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,238 |
2,194 |
$81K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
820 |
492 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
3,316 |
3,247 |
$80K |
| D0140 |
Limited oral evaluation - problem focused |
1,625 |
1,562 |
$54K |
| D1120 |
Prophylaxis - child |
1,650 |
1,608 |
$43K |
| D0330 |
Panoramic radiographic image |
819 |
792 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,267 |
2,212 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
519 |
495 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
841 |
803 |
$33K |
| D0274 |
Bitewings - four radiographic images |
726 |
715 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
241 |
162 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
178 |
79 |
$10K |
| D0272 |
Bitewings - two radiographic images |
509 |
497 |
$9K |
| D4355 |
|
115 |
104 |
$7K |
| D2331 |
|
61 |
39 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
18 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
35 |
35 |
$521.88 |