| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
473 |
461 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
159 |
85 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
78 |
59 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
519 |
504 |
$12K |
| D0274 |
Bitewings - four radiographic images |
381 |
371 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
276 |
271 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
107 |
107 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
349 |
335 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
532 |
508 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
56 |
12 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
148 |
143 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
103 |
103 |
$1K |