| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,335 |
1,284 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
1,123 |
1,081 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
261 |
174 |
$13K |
| D0330 |
Panoramic radiographic image |
282 |
270 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
203 |
138 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
187 |
179 |
$5K |
| D0274 |
Bitewings - four radiographic images |
166 |
159 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
331 |
313 |
$5K |
| D1120 |
Prophylaxis - child |
59 |
55 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
63 |
13 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
117 |
110 |
$1K |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$184.10 |