| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,831 |
1,825 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
1,779 |
1,770 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
266 |
164 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
702 |
694 |
$27K |
| D0274 |
Bitewings - four radiographic images |
698 |
696 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,419 |
1,389 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
187 |
183 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
377 |
373 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
743 |
737 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
88 |
40 |
$8K |
| D0460 |
|
39 |
39 |
$1K |
| D1206 |
Topical application of fluoride varnish |
55 |
52 |
$966.62 |