| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,498 |
2,429 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
3,319 |
3,242 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,742 |
1,721 |
$26K |
| D0272 |
Bitewings - two radiographic images |
2,569 |
2,513 |
$26K |
| D1120 |
Prophylaxis - child |
1,260 |
1,240 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
913 |
844 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
341 |
338 |
$9K |
| D0330 |
Panoramic radiographic image |
135 |
129 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
87 |
27 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
30 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
243 |
220 |
$1K |