| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
438 |
419 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
423 |
407 |
$8K |
| D0274 |
Bitewings - four radiographic images |
281 |
271 |
$7K |
| D0330 |
Panoramic radiographic image |
205 |
186 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
146 |
140 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
39 |
12 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
34 |
16 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
61 |
58 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
86 |
83 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
82 |
80 |
$627.76 |