| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,375 |
3,323 |
$129K |
| D1120 |
Prophylaxis - child |
3,039 |
2,996 |
$88K |
| D1206 |
Topical application of fluoride varnish |
4,983 |
4,922 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
4,797 |
4,724 |
$78K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
999 |
732 |
$76K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
904 |
726 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,669 |
1,415 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
943 |
275 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,470 |
1,453 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,384 |
1,355 |
$25K |
| D9630 |
|
489 |
473 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
587 |
409 |
$5K |
| D0330 |
Panoramic radiographic image |
116 |
66 |
$3K |
| D4910 |
|
12 |
12 |
$735.58 |
| D0140 |
Limited oral evaluation - problem focused |
44 |
25 |
$595.92 |