| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,170 |
1,161 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
1,420 |
1,412 |
$56K |
| D7140 |
Extraction, erupted tooth or exposed root |
187 |
92 |
$24K |
| D0274 |
Bitewings - four radiographic images |
379 |
377 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
159 |
109 |
$19K |
| D1120 |
Prophylaxis - child |
244 |
244 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
106 |
63 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
183 |
183 |
$11K |
| D1310 |
|
670 |
665 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
325 |
323 |
$9K |
| D1330 |
|
684 |
676 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$2K |