| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,086 |
1,077 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,032 |
1,025 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,185 |
1,176 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
278 |
151 |
$18K |
| D0330 |
Panoramic radiographic image |
405 |
402 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
404 |
402 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
108 |
56 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
254 |
251 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
71 |
48 |
$4K |
| D1120 |
Prophylaxis - child |
89 |
88 |
$3K |
| D1351 |
Sealant - per tooth |
85 |
15 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
106 |
103 |
$811.36 |