| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,386 |
2,345 |
$128K |
| D0120 |
Periodic oral evaluation - established patient |
2,293 |
2,265 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
754 |
737 |
$32K |
| D0330 |
Panoramic radiographic image |
723 |
708 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
200 |
156 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,485 |
1,462 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
961 |
956 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
667 |
649 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
194 |
107 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
159 |
89 |
$16K |
| D1120 |
Prophylaxis - child |
323 |
320 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
34 |
25 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
383 |
371 |
$3K |
| D1330 |
|
116 |
116 |
$745.20 |