| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,218 |
1,211 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
640 |
356 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,328 |
1,317 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
336 |
140 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
390 |
248 |
$19K |
| D1120 |
Prophylaxis - child |
440 |
431 |
$13K |
| D1351 |
Sealant - per tooth |
529 |
88 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
748 |
734 |
$12K |
| D0274 |
Bitewings - four radiographic images |
433 |
431 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
276 |
268 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
385 |
382 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
135 |
134 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
55 |
42 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
319 |
307 |
$3K |
| D0272 |
Bitewings - two radiographic images |
80 |
78 |
$1K |
| D2330 |
|
24 |
12 |
$1K |