| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
943 |
924 |
$47K |
| D0330 |
Panoramic radiographic image |
389 |
385 |
$41K |
| D1120 |
Prophylaxis - child |
696 |
681 |
$40K |
| D1110 |
Prophylaxis - adult |
367 |
361 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
656 |
646 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
352 |
343 |
$27K |
| D0272 |
Bitewings - two radiographic images |
608 |
596 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
98 |
54 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
36 |
32 |
$7K |
| D0274 |
Bitewings - four radiographic images |
116 |
114 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
46 |
42 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
45 |
45 |
$1K |