| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
779 |
772 |
$19K |
| D1110 |
Prophylaxis - adult |
377 |
372 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
646 |
639 |
$14K |
| D1120 |
Prophylaxis - child |
343 |
342 |
$12K |
| D0274 |
Bitewings - four radiographic images |
257 |
254 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
103 |
72 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
85 |
53 |
$6K |
| D0330 |
Panoramic radiographic image |
64 |
64 |
$2K |
| D0272 |
Bitewings - two radiographic images |
73 |
73 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
12 |
$988.02 |
| D0220 |
Intraoral - periapical first radiographic image |
16 |
16 |
$192.40 |