| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
485 |
450 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
450 |
422 |
$12K |
| D1110 |
Prophylaxis - adult |
290 |
285 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
329 |
301 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
455 |
415 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
144 |
120 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
120 |
87 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
262 |
249 |
$7K |
| D0274 |
Bitewings - four radiographic images |
321 |
304 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
90 |
67 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
559 |
513 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
174 |
157 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
441 |
405 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$2K |
| D2330 |
|
18 |
13 |
$1K |