| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,231 |
1,153 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
1,269 |
1,184 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
313 |
280 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
534 |
501 |
$17K |
| D4212 |
|
53 |
14 |
$16K |
| D0274 |
Bitewings - four radiographic images |
264 |
255 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
73 |
24 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
303 |
287 |
$4K |
| D0330 |
Panoramic radiographic image |
54 |
52 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
227 |
155 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
24 |
$993.68 |
| D1120 |
Prophylaxis - child |
36 |
29 |
$759.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
16 |
16 |
$358.24 |
| D1206 |
Topical application of fluoride varnish |
15 |
13 |
$293.48 |