| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,107 |
2,032 |
$69K |
| D0330 |
Panoramic radiographic image |
1,525 |
1,457 |
$49K |
| D0274 |
Bitewings - four radiographic images |
2,729 |
2,624 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,889 |
1,804 |
$47K |
| D7140 |
Extraction, erupted tooth or exposed root |
631 |
212 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,675 |
1,620 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
422 |
394 |
$23K |
| D2394 |
|
297 |
184 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
631 |
597 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
750 |
730 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
86 |
57 |
$5K |
| D1120 |
Prophylaxis - child |
229 |
223 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
990 |
915 |
$4K |
| D2332 |
|
27 |
14 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
50 |
40 |
$260.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$120.00 |