| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
776 |
753 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
588 |
574 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
327 |
321 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
180 |
74 |
$8K |
| D0274 |
Bitewings - four radiographic images |
260 |
259 |
$6K |
| D0330 |
Panoramic radiographic image |
135 |
128 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
224 |
214 |
$4K |
| D1120 |
Prophylaxis - child |
99 |
92 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
43 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
18 |
18 |
$405.72 |
| D1999 |
|
14 |
13 |
$0.00 |