| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,588 |
1,578 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
1,893 |
1,887 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
348 |
337 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
902 |
899 |
$16K |
| D1120 |
Prophylaxis - child |
457 |
457 |
$14K |
| D1310 |
|
901 |
896 |
$10K |
| D1330 |
|
888 |
883 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
131 |
51 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
147 |
112 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
170 |
107 |
$8K |
| D0330 |
Panoramic radiographic image |
229 |
225 |
$8K |
| D0274 |
Bitewings - four radiographic images |
154 |
154 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
202 |
201 |
$4K |
| D2330 |
|
49 |
26 |
$2K |