| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,426 |
1,231 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
1,335 |
1,158 |
$29K |
| D0330 |
Panoramic radiographic image |
494 |
391 |
$24K |
| D0274 |
Bitewings - four radiographic images |
584 |
488 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
298 |
269 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
558 |
486 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
59 |
24 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
247 |
195 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
128 |
120 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
140 |
116 |
$1K |
| D1120 |
Prophylaxis - child |
51 |
44 |
$1K |