| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
655 |
591 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
690 |
615 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
395 |
347 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
267 |
250 |
$7K |
| D1110 |
Prophylaxis - adult |
123 |
100 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
707 |
634 |
$3K |
| D0274 |
Bitewings - four radiographic images |
203 |
165 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
33 |
26 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
140 |
131 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
35 |
27 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
386 |
344 |
$2K |
| D9110 |
|
28 |
25 |
$1K |
| D0272 |
Bitewings - two radiographic images |
90 |
83 |
$808.40 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
12 |
$314.10 |