| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
845 |
819 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
461 |
213 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,223 |
1,176 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
418 |
397 |
$25K |
| D1120 |
Prophylaxis - child |
556 |
530 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
596 |
566 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
637 |
613 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
83 |
36 |
$10K |
| D0274 |
Bitewings - four radiographic images |
210 |
204 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
13 |
$1K |
| D9110 |
|
26 |
25 |
$1K |