| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,235 |
2,157 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
4,019 |
3,897 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,174 |
804 |
$60K |
| D1206 |
Topical application of fluoride varnish |
2,457 |
2,391 |
$39K |
| D1120 |
Prophylaxis - child |
1,476 |
1,438 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,317 |
1,279 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
409 |
267 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
223 |
140 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
165 |
157 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
61 |
44 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
27 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
74 |
71 |
$1K |
| D0272 |
Bitewings - two radiographic images |
137 |
130 |
$1K |