| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
815 |
770 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,227 |
1,170 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,075 |
1,003 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
641 |
584 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
483 |
458 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
242 |
220 |
$15K |
| D1120 |
Prophylaxis - child |
442 |
412 |
$10K |
| D0274 |
Bitewings - four radiographic images |
248 |
229 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
458 |
432 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
60 |
39 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
34 |
24 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
13 |
$855.75 |