| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,893 |
1,734 |
$86K |
| D0210 |
Intraoral - complete series of radiographic images |
1,316 |
1,080 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,550 |
1,367 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
1,994 |
1,866 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
648 |
324 |
$43K |
| D0274 |
Bitewings - four radiographic images |
858 |
796 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,302 |
1,229 |
$23K |
| D1120 |
Prophylaxis - child |
802 |
746 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
220 |
146 |
$11K |
| D0330 |
Panoramic radiographic image |
241 |
227 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
71 |
25 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
184 |
166 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
536 |
475 |
$6K |
| D1206 |
Topical application of fluoride varnish |
235 |
197 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
301 |
225 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
25 |
14 |
$2K |
| D0272 |
Bitewings - two radiographic images |
55 |
51 |
$1K |