| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
494 |
444 |
$20K |
| D1110 |
Prophylaxis - adult |
490 |
445 |
$17K |
| D0330 |
Panoramic radiographic image |
312 |
279 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
114 |
70 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
778 |
704 |
$11K |
| D0274 |
Bitewings - four radiographic images |
342 |
324 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
779 |
543 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
258 |
247 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
36 |
25 |
$5K |
| D1206 |
Topical application of fluoride varnish |
212 |
202 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
50 |
24 |
$3K |
| D1120 |
Prophylaxis - child |
94 |
90 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
13 |
$1K |