| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,299 |
1,229 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
1,594 |
1,504 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
593 |
524 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,119 |
1,031 |
$18K |
| D0274 |
Bitewings - four radiographic images |
606 |
563 |
$18K |
| D1120 |
Prophylaxis - child |
545 |
504 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
156 |
140 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
203 |
187 |
$6K |
| D0330 |
Panoramic radiographic image |
149 |
140 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
80 |
44 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
52 |
12 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
235 |
197 |
$2K |