| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
755 |
749 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
606 |
600 |
$15K |
| D0274 |
Bitewings - four radiographic images |
348 |
347 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
166 |
74 |
$9K |
| D0330 |
Panoramic radiographic image |
233 |
232 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
318 |
318 |
$8K |
| D1351 |
Sealant - per tooth |
308 |
45 |
$8K |
| D0272 |
Bitewings - two radiographic images |
179 |
177 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
292 |
291 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
241 |
240 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
26 |
14 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
36 |
36 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25 |
14 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
62 |
62 |
$1K |