| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
437 |
424 |
$22K |
| D1120 |
Prophylaxis - child |
236 |
218 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
138 |
133 |
$9K |
| D0274 |
Bitewings - four radiographic images |
251 |
243 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
358 |
349 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
93 |
54 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
267 |
258 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
188 |
178 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
46 |
14 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
145 |
138 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
276 |
263 |
$4K |
| D1351 |
Sealant - per tooth |
97 |
16 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
182 |
153 |
$2K |