| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,943 |
1,620 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
365 |
163 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,029 |
933 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,704 |
1,403 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
427 |
391 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
557 |
382 |
$7K |
| D0272 |
Bitewings - two radiographic images |
415 |
355 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
59 |
25 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
127 |
113 |
$2K |
| D0330 |
Panoramic radiographic image |
13 |
12 |
$572.50 |