| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
2,068 |
2,001 |
$72K |
| D1110 |
Prophylaxis - adult |
1,165 |
1,164 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,139 |
1,138 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,200 |
2,196 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,151 |
1,150 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,090 |
1,090 |
$28K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
250 |
150 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,090 |
2,053 |
$27K |
| D0330 |
Panoramic radiographic image |
587 |
583 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
231 |
93 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
209 |
209 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,046 |
982 |
$9K |
| D4910 |
|
137 |
137 |
$9K |
| D4355 |
|
137 |
137 |
$9K |
| D4342 |
|
88 |
27 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
79 |
43 |
$5K |
| D2332 |
|
25 |
15 |
$2K |
| D1120 |
Prophylaxis - child |
39 |
39 |
$2K |
| D9110 |
|
26 |
26 |
$1K |
| D1999 |
|
148 |
113 |
$875.00 |
| D1330 |
|
84 |
83 |
$760.00 |
| D0191 |
|
27 |
27 |
$486.00 |
| D0270 |
|
12 |
12 |
$132.00 |