| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,582 |
1,490 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
1,720 |
1,629 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
345 |
237 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,098 |
1,020 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
901 |
830 |
$31K |
| D0330 |
Panoramic radiographic image |
428 |
408 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,149 |
1,025 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
899 |
869 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
172 |
118 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
309 |
290 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
116 |
53 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
76 |
53 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
683 |
547 |
$8K |
| D1120 |
Prophylaxis - child |
288 |
273 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
42 |
25 |
$3K |
| D0272 |
Bitewings - two radiographic images |
120 |
115 |
$2K |
| D2332 |
|
21 |
14 |
$2K |
| D4355 |
|
25 |
25 |
$2K |