| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,086 |
1,083 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
717 |
716 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,140 |
1,131 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,549 |
1,544 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
1,036 |
1,031 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
256 |
179 |
$19K |
| D0274 |
Bitewings - four radiographic images |
1,309 |
1,307 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,656 |
751 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,178 |
1,160 |
$11K |
| D4910 |
|
95 |
95 |
$6K |
| D4341 |
|
31 |
15 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
61 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
583 |
583 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
13 |
$1K |