| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,801 |
1,637 |
$76K |
| D0274 |
Bitewings - four radiographic images |
1,838 |
1,661 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,785 |
1,631 |
$42K |
| D1206 |
Topical application of fluoride varnish |
1,090 |
1,007 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
657 |
608 |
$22K |
| D0330 |
Panoramic radiographic image |
250 |
229 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
192 |
107 |
$15K |
| D1120 |
Prophylaxis - child |
437 |
404 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
382 |
353 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
60 |
14 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
57 |
28 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
635 |
590 |
$5K |
| D2950 |
|
13 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
81 |
81 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
19 |
14 |
$1K |