| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,384 |
2,326 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
2,600 |
2,469 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
543 |
308 |
$53K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
308 |
194 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,015 |
1,880 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
824 |
735 |
$28K |
| D0330 |
Panoramic radiographic image |
428 |
410 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
516 |
490 |
$22K |
| D0274 |
Bitewings - four radiographic images |
663 |
641 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,273 |
1,194 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,115 |
779 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
91 |
24 |
$10K |
| D1120 |
Prophylaxis - child |
312 |
294 |
$8K |
| D0272 |
Bitewings - two radiographic images |
398 |
377 |
$7K |
| D2394 |
|
67 |
28 |
$7K |
| D2332 |
|
75 |
37 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
71 |
40 |
$5K |
| D2335 |
|
46 |
24 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
50 |
25 |
$3K |
| D4355 |
|
41 |
38 |
$3K |