| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,617 |
1,452 |
$53K |
| D7140 |
Extraction, erupted tooth or exposed root |
641 |
277 |
$40K |
| D0330 |
Panoramic radiographic image |
866 |
778 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
541 |
368 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
529 |
320 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
1,462 |
1,342 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
865 |
771 |
$22K |
| D1120 |
Prophylaxis - child |
640 |
597 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
737 |
683 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
122 |
85 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
259 |
242 |
$7K |
| D0274 |
Bitewings - four radiographic images |
196 |
189 |
$5K |
| D2330 |
|
32 |
24 |
$2K |
| D0272 |
Bitewings - two radiographic images |
125 |
120 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
140 |
128 |
$903.33 |