| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,291 |
1,274 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
1,907 |
1,889 |
$57K |
| D1206 |
Topical application of fluoride varnish |
1,785 |
1,764 |
$45K |
| D1120 |
Prophylaxis - child |
872 |
860 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
710 |
604 |
$33K |
| D0330 |
Panoramic radiographic image |
612 |
604 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
460 |
456 |
$26K |
| D0274 |
Bitewings - four radiographic images |
793 |
784 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
510 |
506 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
92 |
28 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
66 |
41 |
$9K |
| D9910 |
|
894 |
881 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
623 |
594 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
443 |
430 |
$6K |