| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,155 |
3,147 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
3,472 |
3,466 |
$64K |
| D0274 |
Bitewings - four radiographic images |
2,557 |
2,557 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
4,123 |
4,103 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,435 |
3,431 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
1,199 |
1,197 |
$28K |
| D1120 |
Prophylaxis - child |
942 |
942 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,559 |
1,558 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
804 |
802 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
104 |
79 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
43 |
29 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
16 |
15 |
$136.97 |
| D1330 |
|
269 |
269 |
$0.00 |