| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,530 |
2,365 |
$104K |
| D0330 |
Panoramic radiographic image |
2,310 |
2,167 |
$93K |
| D1120 |
Prophylaxis - child |
1,707 |
1,635 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,735 |
2,545 |
$65K |
| D0274 |
Bitewings - four radiographic images |
2,174 |
2,034 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
2,069 |
1,989 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,766 |
2,630 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
838 |
613 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
412 |
325 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
318 |
280 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
139 |
103 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
107 |
67 |
$7K |
| D2335 |
|
38 |
25 |
$3K |
| D2332 |
|
36 |
26 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
73 |
27 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
86 |
77 |
$618.49 |