| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
635 |
633 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
573 |
565 |
$11K |
| D0274 |
Bitewings - four radiographic images |
375 |
373 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
137 |
82 |
$8K |
| D0330 |
Panoramic radiographic image |
141 |
141 |
$5K |
| D9110 |
|
145 |
144 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
212 |
212 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
214 |
211 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
284 |
275 |
$2K |
| D8670 |
Periodic orthodontic treatment visit |
36 |
36 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
14 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
14 |
$1K |
| D1120 |
Prophylaxis - child |
40 |
40 |
$1K |
| D1999 |
|
43 |
43 |
$0.00 |