| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
605 |
602 |
$19K |
| D4342 |
|
246 |
58 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
686 |
677 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
175 |
92 |
$9K |
| D0274 |
Bitewings - four radiographic images |
391 |
389 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
233 |
227 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
332 |
326 |
$5K |
| D0330 |
Panoramic radiographic image |
107 |
105 |
$5K |
| D1206 |
Topical application of fluoride varnish |
286 |
286 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
116 |
105 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
55 |
54 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
65 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
72 |
69 |
$1K |