| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
740 |
723 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,465 |
1,408 |
$24K |
| D1120 |
Prophylaxis - child |
974 |
933 |
$22K |
| D0330 |
Panoramic radiographic image |
730 |
697 |
$18K |
| D1206 |
Topical application of fluoride varnish |
1,263 |
1,179 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
743 |
698 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
217 |
157 |
$15K |
| D0274 |
Bitewings - four radiographic images |
775 |
749 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
168 |
127 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
246 |
243 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
85 |
37 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
464 |
447 |
$4K |
| D0272 |
Bitewings - two radiographic images |
197 |
184 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$597.38 |