| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,869 |
1,858 |
$67K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,062 |
612 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
2,508 |
2,494 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,032 |
2,024 |
$38K |
| D1120 |
Prophylaxis - child |
1,198 |
1,194 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
544 |
325 |
$27K |
| D0274 |
Bitewings - four radiographic images |
937 |
931 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
331 |
208 |
$21K |
| D1351 |
Sealant - per tooth |
741 |
103 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
488 |
486 |
$10K |
| D0272 |
Bitewings - two radiographic images |
375 |
374 |
$6K |
| D0330 |
Panoramic radiographic image |
133 |
133 |
$5K |
| D1330 |
|
475 |
474 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
65 |
52 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
225 |
223 |
$2K |