| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,587 |
2,587 |
$129K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,297 |
810 |
$112K |
| D0120 |
Periodic oral evaluation - established patient |
4,038 |
4,038 |
$91K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
673 |
431 |
$51K |
| D1120 |
Prophylaxis - child |
1,410 |
1,410 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
504 |
340 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,557 |
2,557 |
$42K |
| D0272 |
Bitewings - two radiographic images |
2,164 |
2,164 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,409 |
1,409 |
$39K |
| D0330 |
Panoramic radiographic image |
763 |
763 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
496 |
493 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
501 |
496 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
48 |
48 |
$2K |
| D2330 |
|
22 |
12 |
$1K |