| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,188 |
2,175 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
2,234 |
2,227 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
626 |
382 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
772 |
745 |
$35K |
| D2750 |
|
48 |
43 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,632 |
1,625 |
$19K |
| D1120 |
Prophylaxis - child |
477 |
476 |
$19K |
| D1206 |
Topical application of fluoride varnish |
531 |
531 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,631 |
2,573 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,194 |
2,083 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
236 |
236 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
131 |
102 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
346 |
346 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
310 |
310 |
$8K |
| D2954 |
|
32 |
26 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
35 |
13 |
$2K |
| D0270 |
|
97 |
96 |
$485.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
12 |
$130.00 |
| D0603 |
|
12 |
12 |
$120.00 |
| D1999 |
|
12 |
12 |
$0.00 |