| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,109 |
1,038 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,088 |
1,015 |
$16K |
| D0274 |
Bitewings - four radiographic images |
974 |
890 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
603 |
572 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
248 |
139 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
260 |
207 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
151 |
79 |
$7K |
| D1120 |
Prophylaxis - child |
375 |
356 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,634 |
1,477 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
474 |
448 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,467 |
1,216 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
158 |
144 |
$3K |
| D0330 |
Panoramic radiographic image |
162 |
154 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
73 |
68 |
$660.00 |