| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,195 |
2,093 |
$103K |
| D0120 |
Periodic oral evaluation - established patient |
3,172 |
3,032 |
$78K |
| D1206 |
Topical application of fluoride varnish |
3,442 |
3,305 |
$63K |
| D0274 |
Bitewings - four radiographic images |
1,615 |
1,540 |
$47K |
| D1120 |
Prophylaxis - child |
1,808 |
1,766 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
164 |
82 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
262 |
167 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
775 |
706 |
$10K |
| D0330 |
Panoramic radiographic image |
150 |
141 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
57 |
41 |
$6K |
| D0272 |
Bitewings - two radiographic images |
221 |
212 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
333 |
298 |
$3K |
| D1351 |
Sealant - per tooth |
989 |
347 |
$3K |
| D1330 |
|
991 |
991 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
56 |
55 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
61 |
39 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$0.00 |