| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,632 |
1,598 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,092 |
1,799 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,524 |
1,471 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,749 |
1,702 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,595 |
2,464 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
662 |
649 |
$16K |
| D0274 |
Bitewings - four radiographic images |
667 |
635 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
243 |
238 |
$12K |
| D1120 |
Prophylaxis - child |
172 |
158 |
$4K |
| D1206 |
Topical application of fluoride varnish |
209 |
193 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
37 |
15 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
58 |
56 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
16 |
15 |
$229.18 |
| D0602 |
|
18 |
12 |
$0.00 |