| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,647 |
1,279 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
1,784 |
1,430 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
345 |
105 |
$16K |
| D1206 |
Topical application of fluoride varnish |
971 |
791 |
$13K |
| D0272 |
Bitewings - two radiographic images |
834 |
640 |
$11K |
| D1120 |
Prophylaxis - child |
393 |
326 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
88 |
54 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
228 |
157 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
26 |
12 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
26 |
13 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
112 |
89 |
$1K |