| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,357 |
1,351 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,532 |
1,525 |
$95K |
| D0210 |
Intraoral - complete series of radiographic images |
1,502 |
1,490 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
921 |
916 |
$40K |
| D9430 |
|
734 |
712 |
$23K |
| D0274 |
Bitewings - four radiographic images |
522 |
518 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
651 |
633 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
122 |
75 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
92 |
74 |
$6K |
| D4910 |
|
69 |
69 |
$5K |
| D1206 |
Topical application of fluoride varnish |
295 |
290 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
95 |
42 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
974 |
645 |
$4K |
| D9110 |
|
25 |
25 |
$2K |
| D0330 |
Panoramic radiographic image |
40 |
36 |
$967.50 |
| D0270 |
|
42 |
42 |
$200.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
124 |
118 |
$50.00 |