| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,022 |
2,921 |
$116K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,311 |
862 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
3,140 |
3,067 |
$60K |
| D0274 |
Bitewings - four radiographic images |
1,597 |
1,538 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
956 |
881 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
425 |
302 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,226 |
1,193 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
732 |
690 |
$15K |
| D1120 |
Prophylaxis - child |
702 |
680 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
117 |
72 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
110 |
101 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
1,032 |
961 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
46 |
13 |
$3K |
| D2394 |
|
31 |
25 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
295 |
141 |
$1K |