| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,044 |
1,028 |
$60K |
| D0272 |
Bitewings - two radiographic images |
1,557 |
1,541 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,260 |
1,246 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,065 |
1,058 |
$32K |
| D1120 |
Prophylaxis - child |
451 |
449 |
$24K |
| D0330 |
Panoramic radiographic image |
343 |
338 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
465 |
460 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
248 |
247 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
663 |
645 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
101 |
58 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
113 |
61 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
14 |
$2K |
| D1351 |
Sealant - per tooth |
38 |
14 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
31 |
25 |
$405.00 |