| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,897 |
2,843 |
$102K |
| D0140 |
Limited oral evaluation - problem focused |
3,371 |
3,154 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
3,755 |
3,694 |
$91K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,204 |
3,153 |
$67K |
| D0210 |
Intraoral - complete series of radiographic images |
897 |
882 |
$50K |
| D1120 |
Prophylaxis - child |
1,058 |
1,051 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,141 |
1,121 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
1,962 |
1,827 |
$21K |
| D0330 |
Panoramic radiographic image |
179 |
177 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
203 |
202 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
652 |
411 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
29 |
12 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
13 |
$905.16 |