| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,310 |
1,300 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
993 |
978 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,565 |
1,552 |
$37K |
| D0330 |
Panoramic radiographic image |
749 |
740 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,139 |
1,128 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
681 |
679 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
99 |
71 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
120 |
74 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
698 |
691 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
66 |
39 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
115 |
115 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
167 |
162 |
$2K |
| D1120 |
Prophylaxis - child |
30 |
30 |
$1K |