| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,470 |
1,419 |
$52K |
| D0330 |
Panoramic radiographic image |
1,095 |
1,049 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,477 |
1,430 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,123 |
1,093 |
$19K |
| D0274 |
Bitewings - four radiographic images |
679 |
650 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
697 |
644 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
161 |
98 |
$10K |
| D1120 |
Prophylaxis - child |
419 |
405 |
$9K |
| D2332 |
|
94 |
39 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
464 |
448 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
14 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
14 |
$972.00 |