| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,139 |
2,040 |
$104K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,043 |
587 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
2,614 |
2,501 |
$61K |
| D0210 |
Intraoral - complete series of radiographic images |
895 |
829 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,130 |
1,067 |
$41K |
| D1206 |
Topical application of fluoride varnish |
1,952 |
1,862 |
$39K |
| D1120 |
Prophylaxis - child |
946 |
913 |
$29K |
| D0274 |
Bitewings - four radiographic images |
712 |
684 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
111 |
77 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
127 |
41 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
171 |
162 |
$6K |
| D1354 |
|
134 |
61 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
69 |
39 |
$4K |
| D0330 |
Panoramic radiographic image |
25 |
24 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
144 |
136 |
$2K |