| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,459 |
1,402 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
1,999 |
1,927 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
322 |
100 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,053 |
1,013 |
$19K |
| D0274 |
Bitewings - four radiographic images |
329 |
316 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
289 |
280 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
108 |
106 |
$7K |
| D1120 |
Prophylaxis - child |
242 |
230 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
39 |
24 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
110 |
105 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
78 |
75 |
$975.76 |
| D0272 |
Bitewings - two radiographic images |
14 |
13 |
$274.72 |