| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,831 |
1,773 |
$71K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
621 |
472 |
$47K |
| D1206 |
Topical application of fluoride varnish |
2,507 |
2,419 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
2,100 |
2,037 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
801 |
768 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
503 |
334 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
356 |
157 |
$18K |
| D0274 |
Bitewings - four radiographic images |
1,391 |
1,339 |
$18K |
| D1120 |
Prophylaxis - child |
546 |
528 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
612 |
581 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
496 |
458 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,377 |
1,268 |
$11K |
| D0330 |
Panoramic radiographic image |
975 |
934 |
$9K |
| D2950 |
|
76 |
66 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
717 |
388 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
25 |
$3K |
| D2331 |
|
18 |
12 |
$1K |
| D0460 |
|
210 |
194 |
$1K |
| D0272 |
Bitewings - two radiographic images |
59 |
58 |
$952.44 |