| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,155 |
1,153 |
$44K |
| D1110 |
Prophylaxis - adult |
818 |
815 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,383 |
1,380 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,308 |
1,306 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
262 |
165 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
522 |
521 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
198 |
111 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,076 |
1,052 |
$17K |
| D0272 |
Bitewings - two radiographic images |
555 |
553 |
$13K |
| D0274 |
Bitewings - four radiographic images |
309 |
308 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
205 |
204 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
828 |
762 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
101 |
100 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
26 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
13 |
$1K |