| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1354 |
|
2,899 |
616 |
$112K |
| D0120 |
Periodic oral evaluation - established patient |
1,171 |
1,124 |
$22K |
| D1110 |
Prophylaxis - adult |
570 |
549 |
$21K |
| D1120 |
Prophylaxis - child |
660 |
646 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
274 |
209 |
$19K |
| D0330 |
Panoramic radiographic image |
337 |
320 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
149 |
113 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
631 |
614 |
$9K |
| D1206 |
Topical application of fluoride varnish |
398 |
394 |
$9K |
| D1999 |
|
1,489 |
1,294 |
$8K |
| D0274 |
Bitewings - four radiographic images |
187 |
175 |
$4K |
| D0272 |
Bitewings - two radiographic images |
172 |
169 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
79 |
75 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
15 |
12 |
$704.00 |
| D0220 |
Intraoral - periapical first radiographic image |
30 |
27 |
$288.75 |