| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
1,308 |
1,264 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
1,145 |
1,106 |
$39K |
| D1110 |
Prophylaxis - adult |
643 |
618 |
$36K |
| D1120 |
Prophylaxis - child |
869 |
846 |
$35K |
| D0330 |
Panoramic radiographic image |
441 |
420 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
387 |
375 |
$23K |
| D0274 |
Bitewings - four radiographic images |
427 |
414 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
95 |
41 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
158 |
152 |
$9K |
| D0272 |
Bitewings - two radiographic images |
279 |
273 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
78 |
50 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
305 |
293 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
112 |
100 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
147 |
98 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21 |
16 |
$904.00 |