| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,762 |
1,709 |
$85K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
940 |
528 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
1,956 |
1,955 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,542 |
1,491 |
$42K |
| D1206 |
Topical application of fluoride varnish |
2,213 |
2,155 |
$36K |
| D1120 |
Prophylaxis - child |
963 |
942 |
$33K |
| D0330 |
Panoramic radiographic image |
649 |
617 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
624 |
561 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
193 |
116 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
199 |
126 |
$17K |
| D0272 |
Bitewings - two radiographic images |
563 |
549 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
130 |
128 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
42 |
33 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
183 |
180 |
$2K |