| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,613 |
1,248 |
$45K |
| D1120 |
Prophylaxis - child |
2,364 |
1,800 |
$43K |
| D0330 |
Panoramic radiographic image |
1,157 |
893 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,160 |
822 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
453 |
109 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,443 |
1,082 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
958 |
745 |
$15K |
| D0272 |
Bitewings - two radiographic images |
997 |
770 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
653 |
484 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$1K |