| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
829 |
828 |
$23K |
| D1120 |
Prophylaxis - child |
508 |
508 |
$21K |
| D1110 |
Prophylaxis - adult |
450 |
449 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
212 |
183 |
$14K |
| D9110 |
|
261 |
258 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
382 |
381 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
334 |
334 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
358 |
357 |
$7K |
| D0330 |
Panoramic radiographic image |
208 |
207 |
$5K |
| D0274 |
Bitewings - four radiographic images |
267 |
266 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
543 |
453 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
652 |
648 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
217 |
214 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
73 |
64 |
$3K |
| D4341 |
|
21 |
12 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
20 |
$2K |