| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,940 |
1,845 |
$74K |
| D0330 |
Panoramic radiographic image |
1,287 |
1,209 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
738 |
294 |
$49K |
| D7140 |
Extraction, erupted tooth or exposed root |
303 |
175 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
919 |
866 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
1,300 |
1,248 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
784 |
729 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
211 |
133 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,238 |
1,165 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
666 |
617 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
133 |
130 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
14 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
84 |
80 |
$335.31 |