| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
252 |
236 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
334 |
313 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
250 |
234 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
96 |
52 |
$5K |
| D0274 |
Bitewings - four radiographic images |
183 |
171 |
$3K |
| D1110 |
Prophylaxis - adult |
70 |
65 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
56 |
44 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
77 |
72 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
47 |
33 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
15 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
210 |
193 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
60 |
52 |
$972.40 |
| D0230 |
Intraoral - periapical each additional radiographic image |
175 |
155 |
$805.60 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$178.20 |