| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
473 |
469 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
228 |
224 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
195 |
187 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
311 |
309 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
59 |
40 |
$11K |
| D0274 |
Bitewings - four radiographic images |
150 |
150 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
71 |
70 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
202 |
196 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
174 |
173 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
13 |
$3K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$768.00 |
| D1999 |
|
89 |
75 |
$602.00 |
| D1206 |
Topical application of fluoride varnish |
15 |
15 |
$576.00 |