| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,730 |
2,808 |
$136K |
| D0120 |
Periodic oral evaluation - established patient |
3,779 |
2,973 |
$84K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
736 |
369 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,811 |
1,324 |
$61K |
| D0210 |
Intraoral - complete series of radiographic images |
1,261 |
924 |
$51K |
| D1120 |
Prophylaxis - child |
856 |
823 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,447 |
1,034 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
764 |
747 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
254 |
150 |
$13K |
| D0272 |
Bitewings - two radiographic images |
648 |
596 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
197 |
82 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
58 |
39 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
50 |
47 |
$1K |
| D1206 |
Topical application of fluoride varnish |
36 |
36 |
$631.54 |
| D0220 |
Intraoral - periapical first radiographic image |
43 |
40 |
$576.63 |