| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,681 |
1,657 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
1,764 |
1,729 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
687 |
288 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
173 |
108 |
$17K |
| D0274 |
Bitewings - four radiographic images |
558 |
543 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
424 |
403 |
$15K |
| D0330 |
Panoramic radiographic image |
246 |
241 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
271 |
266 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
632 |
625 |
$10K |
| D4355 |
|
45 |
43 |
$3K |
| D1120 |
Prophylaxis - child |
90 |
89 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
34 |
18 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
13 |
$2K |