| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,353 |
1,334 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
2,436 |
2,380 |
$56K |
| D4346 |
|
321 |
297 |
$49K |
| D1120 |
Prophylaxis - child |
943 |
922 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
1,034 |
922 |
$29K |
| D0330 |
Panoramic radiographic image |
515 |
494 |
$27K |
| D0274 |
Bitewings - four radiographic images |
807 |
781 |
$25K |
| D1206 |
Topical application of fluoride varnish |
1,285 |
1,253 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
87 |
44 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
196 |
188 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
246 |
245 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
46 |
24 |
$3K |
| D0272 |
Bitewings - two radiographic images |
93 |
90 |
$2K |
| D2140 |
|
36 |
20 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
147 |
121 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22 |
16 |
$1K |