| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
888 |
883 |
$26K |
| D1120 |
Prophylaxis - child |
553 |
550 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
572 |
570 |
$17K |
| D0274 |
Bitewings - four radiographic images |
426 |
424 |
$15K |
| D0330 |
Panoramic radiographic image |
244 |
241 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
152 |
119 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
260 |
258 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
141 |
101 |
$12K |
| D1110 |
Prophylaxis - adult |
229 |
226 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
56 |
44 |
$5K |
| D0272 |
Bitewings - two radiographic images |
111 |
111 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
37 |
37 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
14 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
28 |
28 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
15 |
$1K |