| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,974 |
1,932 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
2,961 |
2,872 |
$72K |
| D7140 |
Extraction, erupted tooth or exposed root |
408 |
169 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
524 |
503 |
$18K |
| D0330 |
Panoramic radiographic image |
293 |
287 |
$16K |
| D1120 |
Prophylaxis - child |
573 |
553 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
511 |
493 |
$8K |
| D0272 |
Bitewings - two radiographic images |
258 |
258 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
27 |
24 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
192 |
166 |
$3K |
| D9110 |
|
40 |
40 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13 |
12 |
$1K |