| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
697 |
566 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,258 |
1,026 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
323 |
143 |
$19K |
| D0274 |
Bitewings - four radiographic images |
354 |
280 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
592 |
482 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
190 |
150 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
151 |
137 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
68 |
49 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
34 |
15 |
$3K |
| D0330 |
Panoramic radiographic image |
67 |
64 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
107 |
101 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
43 |
38 |
$1K |
| D1120 |
Prophylaxis - child |
53 |
40 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
13 |
$0.00 |