| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
982 |
876 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,187 |
1,050 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
322 |
285 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
474 |
439 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
125 |
86 |
$7K |
| D0274 |
Bitewings - four radiographic images |
328 |
314 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
217 |
198 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
1,017 |
878 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
63 |
46 |
$4K |
| D1120 |
Prophylaxis - child |
183 |
169 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
870 |
321 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
48 |
12 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
13 |
$660.00 |