| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
449 |
444 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
686 |
678 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
473 |
467 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
132 |
101 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
149 |
103 |
$6K |
| D1120 |
Prophylaxis - child |
325 |
320 |
$6K |
| D0330 |
Panoramic radiographic image |
112 |
109 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
26 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
71 |
70 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
30 |
13 |
$2K |
| D0274 |
Bitewings - four radiographic images |
88 |
86 |
$2K |
| D0272 |
Bitewings - two radiographic images |
63 |
63 |
$620.00 |
| D0220 |
Intraoral - periapical first radiographic image |
87 |
85 |
$390.00 |