| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,050 |
5,915 |
$288K |
| D0274 |
Bitewings - four radiographic images |
2,909 |
2,854 |
$96K |
| D1120 |
Prophylaxis - child |
885 |
870 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,728 |
1,703 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
488 |
338 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,249 |
1,242 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
392 |
385 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
450 |
443 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
649 |
615 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
100 |
76 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
64 |
63 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
53 |
39 |
$2K |
| D0330 |
Panoramic radiographic image |
40 |
39 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
26 |
12 |
$2K |
| D2394 |
|
17 |
12 |
$2K |
| D3120 |
|
28 |
12 |
$988.00 |