| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
294 |
289 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
447 |
437 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
125 |
103 |
$6K |
| D1120 |
Prophylaxis - child |
152 |
151 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
126 |
97 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
128 |
73 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
152 |
141 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
191 |
187 |
$3K |
| D0330 |
Panoramic radiographic image |
68 |
68 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
261 |
248 |
$2K |
| D2330 |
|
38 |
24 |
$2K |
| D0274 |
Bitewings - four radiographic images |
63 |
62 |
$1K |
| D0272 |
Bitewings - two radiographic images |
49 |
47 |
$712.60 |
| D0120 |
Periodic oral evaluation - established patient |
13 |
13 |
$214.25 |