| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,747 |
1,591 |
$34K |
| D1110 |
Prophylaxis - adult |
607 |
570 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
294 |
150 |
$10K |
| D0274 |
Bitewings - four radiographic images |
347 |
323 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
92 |
68 |
$5K |
| D1120 |
Prophylaxis - child |
136 |
124 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
550 |
508 |
$4K |
| D0330 |
Panoramic radiographic image |
63 |
60 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
170 |
146 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
66 |
29 |
$2K |
| D9110 |
|
70 |
68 |
$1K |