| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,035 |
2,730 |
$141K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,036 |
612 |
$76K |
| D7140 |
Extraction, erupted tooth or exposed root |
991 |
372 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
2,857 |
2,582 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,334 |
1,161 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,248 |
1,135 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
652 |
580 |
$40K |
| D1206 |
Topical application of fluoride varnish |
1,676 |
1,484 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
982 |
894 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
510 |
325 |
$29K |
| D1120 |
Prophylaxis - child |
787 |
714 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
136 |
90 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,168 |
1,039 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
31 |
24 |
$341.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
42 |
38 |
$54.00 |