| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,935 |
1,863 |
$61K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
844 |
519 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,804 |
1,731 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
649 |
257 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
530 |
519 |
$22K |
| D0274 |
Bitewings - four radiographic images |
769 |
735 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
444 |
282 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
223 |
171 |
$13K |
| D9110 |
|
324 |
311 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
275 |
273 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
664 |
631 |
$5K |
| D2332 |
|
22 |
12 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
74 |
74 |
$1K |
| D2331 |
|
13 |
12 |
$692.82 |
| D0230 |
Intraoral - periapical each additional radiographic image |
65 |
39 |
$321.59 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$304.74 |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$247.05 |