| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,912 |
3,398 |
$179K |
| D0120 |
Periodic oral evaluation - established patient |
5,051 |
4,338 |
$109K |
| D1206 |
Topical application of fluoride varnish |
3,561 |
3,062 |
$63K |
| D1120 |
Prophylaxis - child |
1,925 |
1,599 |
$58K |
| D0210 |
Intraoral - complete series of radiographic images |
678 |
559 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
427 |
267 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
820 |
690 |
$28K |
| D0274 |
Bitewings - four radiographic images |
751 |
632 |
$28K |
| D0272 |
Bitewings - two radiographic images |
608 |
555 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
280 |
198 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
287 |
228 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
44 |
13 |
$4K |
| D1351 |
Sealant - per tooth |
192 |
33 |
$2K |
| D0330 |
Panoramic radiographic image |
31 |
27 |
$2K |