| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,204 |
2,956 |
$139K |
| D0120 |
Periodic oral evaluation - established patient |
3,797 |
3,525 |
$78K |
| D0274 |
Bitewings - four radiographic images |
1,458 |
1,350 |
$47K |
| D1120 |
Prophylaxis - child |
1,190 |
1,101 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
968 |
867 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,756 |
1,639 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
177 |
122 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
177 |
158 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
112 |
53 |
$9K |
| D1206 |
Topical application of fluoride varnish |
254 |
233 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
340 |
296 |
$4K |
| D0272 |
Bitewings - two radiographic images |
131 |
112 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
39 |
28 |
$3K |
| D0330 |
Panoramic radiographic image |
40 |
38 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
47 |
44 |
$2K |
| D1999 |
|
37 |
32 |
$10.00 |