| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
957 |
876 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
732 |
665 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
279 |
152 |
$27K |
| D0274 |
Bitewings - four radiographic images |
741 |
686 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
567 |
518 |
$13K |
| D1206 |
Topical application of fluoride varnish |
855 |
784 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
146 |
84 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
76 |
24 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
337 |
307 |
$5K |
| D0330 |
Panoramic radiographic image |
73 |
70 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
112 |
98 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
86 |
82 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
178 |
101 |
$2K |