| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
507 |
496 |
$41K |
| D1120 |
Prophylaxis - child |
551 |
546 |
$35K |
| D1206 |
Topical application of fluoride varnish |
788 |
772 |
$32K |
| D0330 |
Panoramic radiographic image |
275 |
273 |
$29K |
| D1110 |
Prophylaxis - adult |
279 |
279 |
$24K |
| D0274 |
Bitewings - four radiographic images |
409 |
407 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
104 |
80 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
112 |
54 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
418 |
415 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
86 |
50 |
$10K |
| D0272 |
Bitewings - two radiographic images |
234 |
234 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
132 |
131 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
217 |
214 |
$6K |
| D1351 |
Sealant - per tooth |
43 |
14 |
$1K |