| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,417 |
1,378 |
$72K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
363 |
133 |
$43K |
| D0330 |
Panoramic radiographic image |
575 |
542 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
700 |
683 |
$28K |
| D9450 |
|
1,574 |
1,249 |
$23K |
| D0274 |
Bitewings - four radiographic images |
698 |
667 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
464 |
439 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
490 |
473 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
82 |
46 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
348 |
323 |
$4K |
| D1120 |
Prophylaxis - child |
25 |
25 |
$1K |
| D1206 |
Topical application of fluoride varnish |
40 |
39 |
$985.00 |