| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,036 |
1,034 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
1,231 |
1,224 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,798 |
1,781 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,011 |
1,003 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
218 |
216 |
$11K |
| D1120 |
Prophylaxis - child |
239 |
239 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
251 |
248 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
79 |
37 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
63 |
51 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
71 |
68 |
$2K |
| D4910 |
|
27 |
27 |
$1K |
| D0603 |
|
317 |
313 |
$942.35 |
| D0220 |
Intraoral - periapical first radiographic image |
60 |
58 |
$546.00 |
| D4346 |
|
12 |
12 |
$484.00 |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$280.00 |
| D0601 |
|
78 |
78 |
$66.00 |
| D1330 |
|
637 |
603 |
$44.35 |
| D1310 |
|
474 |
451 |
$33.35 |
| D0602 |
|
32 |
32 |
$23.00 |