| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,760 |
1,607 |
$66K |
| D1110 |
Prophylaxis - adult |
948 |
862 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
1,896 |
1,646 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,099 |
1,825 |
$44K |
| D1120 |
Prophylaxis - child |
1,062 |
912 |
$37K |
| D0272 |
Bitewings - two radiographic images |
1,054 |
925 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
239 |
63 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
179 |
50 |
$19K |
| D0330 |
Panoramic radiographic image |
268 |
247 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
861 |
748 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
39 |
13 |
$5K |