| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,579 |
2,449 |
$108K |
| D0330 |
Panoramic radiographic image |
2,308 |
2,187 |
$96K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,094 |
2,958 |
$77K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,091 |
642 |
$60K |
| D0272 |
Bitewings - two radiographic images |
2,552 |
2,452 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
701 |
411 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
476 |
178 |
$29K |
| D5110 |
|
46 |
43 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
295 |
180 |
$17K |
| D2335 |
|
214 |
125 |
$15K |
| D5120 |
|
28 |
27 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,497 |
1,333 |
$11K |
| D1120 |
Prophylaxis - child |
130 |
125 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
354 |
343 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
125 |
124 |
$3K |
| D2332 |
|
41 |
25 |
$2K |
| D9110 |
|
62 |
62 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
42 |
42 |
$1K |
| D2331 |
|
24 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
218 |
126 |
$1K |
| D0274 |
Bitewings - four radiographic images |
39 |
36 |
$725.66 |
| D9999 |
Unspecified adjunctive procedure, by report |
185 |
177 |
$15.00 |