| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,767 |
2,750 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
3,174 |
3,152 |
$80K |
| D1206 |
Topical application of fluoride varnish |
1,176 |
1,110 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,047 |
1,039 |
$22K |
| D1120 |
Prophylaxis - child |
784 |
781 |
$20K |
| D0330 |
Panoramic radiographic image |
624 |
615 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
709 |
705 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
216 |
57 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
255 |
185 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
551 |
545 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
238 |
238 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
131 |
105 |
$10K |
| D0272 |
Bitewings - two radiographic images |
591 |
590 |
$7K |
| D1999 |
|
186 |
176 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
196 |
190 |
$1K |