| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
594 |
584 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
795 |
767 |
$13K |
| D0274 |
Bitewings - four radiographic images |
553 |
540 |
$11K |
| D1120 |
Prophylaxis - child |
476 |
450 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
585 |
556 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
271 |
261 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
132 |
80 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
98 |
67 |
$5K |
| D0272 |
Bitewings - two radiographic images |
344 |
323 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
134 |
124 |
$3K |
| D2331 |
|
32 |
24 |
$2K |
| D2140 |
|
34 |
16 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
14 |
$969.12 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
13 |
$806.55 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$693.00 |
| D0220 |
Intraoral - periapical first radiographic image |
79 |
72 |
$366.00 |