| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,399 |
2,277 |
$113K |
| D0120 |
Periodic oral evaluation - established patient |
2,771 |
2,622 |
$62K |
| D0274 |
Bitewings - four radiographic images |
1,592 |
1,493 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
345 |
246 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,200 |
1,140 |
$23K |
| D1120 |
Prophylaxis - child |
767 |
724 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
403 |
393 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
284 |
277 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
844 |
788 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
39 |
26 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
338 |
133 |
$2K |