| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,496 |
1,440 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
2,208 |
2,106 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
1,847 |
1,721 |
$27K |
| D0274 |
Bitewings - four radiographic images |
820 |
771 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,203 |
1,117 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
136 |
112 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
298 |
274 |
$5K |
| D1120 |
Prophylaxis - child |
69 |
65 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
12 |
$2K |