| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
599 |
577 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
475 |
456 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
155 |
151 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
483 |
465 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
150 |
84 |
$12K |
| D0274 |
Bitewings - four radiographic images |
432 |
408 |
$12K |
| D0330 |
Panoramic radiographic image |
211 |
203 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
98 |
51 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
404 |
390 |
$9K |
| D1120 |
Prophylaxis - child |
264 |
256 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
61 |
25 |
$6K |
| D0272 |
Bitewings - two radiographic images |
145 |
140 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
43 |
40 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
31 |
27 |
$184.47 |