| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,242 |
1,131 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
1,840 |
1,746 |
$50K |
| D1120 |
Prophylaxis - child |
850 |
824 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,072 |
1,024 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
223 |
140 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
833 |
809 |
$18K |
| D0330 |
Panoramic radiographic image |
93 |
88 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
132 |
115 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
37 |
26 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
275 |
210 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
12 |
$1K |