| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,640 |
1,604 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
2,142 |
2,100 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,530 |
1,501 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,098 |
1,074 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
209 |
148 |
$14K |
| D0330 |
Panoramic radiographic image |
203 |
202 |
$12K |
| D1120 |
Prophylaxis - child |
388 |
376 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
101 |
37 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
89 |
59 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
118 |
115 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
467 |
446 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
88 |
83 |
$2K |
| D0272 |
Bitewings - two radiographic images |
95 |
88 |
$2K |
| D1206 |
Topical application of fluoride varnish |
30 |
30 |
$680.90 |
| D0350 |
|
12 |
12 |
$247.00 |