| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,338 |
2,273 |
$88K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
646 |
459 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
1,998 |
1,946 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,215 |
1,179 |
$37K |
| D0330 |
Panoramic radiographic image |
466 |
446 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
483 |
466 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
112 |
86 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
328 |
317 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
139 |
82 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
555 |
503 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
36 |
26 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
175 |
103 |
$2K |
| D9110 |
|
13 |
13 |
$601.62 |
| D1208 |
Topical application of fluoride, excluding varnish |
26 |
26 |
$393.00 |