| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,181 |
2,063 |
$97K |
| D0120 |
Periodic oral evaluation - established patient |
2,325 |
2,194 |
$48K |
| D0274 |
Bitewings - four radiographic images |
858 |
811 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
299 |
118 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
510 |
469 |
$18K |
| D1206 |
Topical application of fluoride varnish |
638 |
602 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
327 |
301 |
$12K |
| D0330 |
Panoramic radiographic image |
145 |
139 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
92 |
53 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
343 |
307 |
$4K |
| D1120 |
Prophylaxis - child |
134 |
131 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
33 |
30 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
26 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
205 |
198 |
$1K |