| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
1,949 |
1,925 |
$55K |
| D1120 |
Prophylaxis - child |
1,780 |
1,757 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,345 |
1,335 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,522 |
2,488 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
585 |
382 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
536 |
527 |
$32K |
| D1110 |
Prophylaxis - adult |
695 |
686 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,780 |
2,712 |
$30K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
270 |
103 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
509 |
279 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
413 |
265 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
737 |
723 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,276 |
2,192 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
591 |
585 |
$13K |
| D4346 |
|
91 |
91 |
$11K |
| D0330 |
Panoramic radiographic image |
175 |
175 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
57 |
41 |
$5K |
| D2335 |
|
21 |
13 |
$2K |
| D1351 |
Sealant - per tooth |
45 |
14 |
$1K |
| D1206 |
Topical application of fluoride varnish |
42 |
42 |
$683.76 |
| D1999 |
|
24 |
20 |
$0.00 |