| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,555 |
2,197 |
$112K |
| D0120 |
Periodic oral evaluation - established patient |
3,920 |
3,463 |
$92K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
533 |
400 |
$62K |
| D0274 |
Bitewings - four radiographic images |
1,904 |
1,622 |
$53K |
| D1206 |
Topical application of fluoride varnish |
1,228 |
1,113 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
391 |
76 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
307 |
154 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
376 |
338 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
336 |
272 |
$12K |
| D1120 |
Prophylaxis - child |
244 |
235 |
$8K |
| D0330 |
Panoramic radiographic image |
135 |
116 |
$7K |
| D4910 |
|
105 |
95 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
340 |
276 |
$5K |
| D0602 |
|
94 |
94 |
$0.00 |
| D0601 |
|
196 |
194 |
$0.00 |
| D0603 |
|
58 |
57 |
$0.00 |
| Z0062 |
|
114 |
112 |
$0.00 |