| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,487 |
2,249 |
$109K |
| D0120 |
Periodic oral evaluation - established patient |
2,512 |
2,283 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,054 |
944 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
409 |
351 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
403 |
129 |
$23K |
| D0274 |
Bitewings - four radiographic images |
671 |
600 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
305 |
188 |
$20K |
| D1120 |
Prophylaxis - child |
664 |
613 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
863 |
780 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
373 |
317 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
65 |
24 |
$10K |
| D4346 |
|
34 |
26 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
321 |
272 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
19 |
16 |
$1K |
| D1206 |
Topical application of fluoride varnish |
13 |
12 |
$267.00 |