| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,003 |
976 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,755 |
1,694 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,123 |
1,089 |
$16K |
| D1110 |
Prophylaxis - adult |
422 |
396 |
$15K |
| D0330 |
Panoramic radiographic image |
333 |
311 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
165 |
122 |
$9K |
| D0274 |
Bitewings - four radiographic images |
312 |
294 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
108 |
66 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
84 |
54 |
$3K |
| D9110 |
|
177 |
146 |
$3K |
| D0272 |
Bitewings - two radiographic images |
66 |
66 |
$1K |
| D2330 |
|
18 |
13 |
$685.08 |
| D1206 |
Topical application of fluoride varnish |
29 |
29 |
$475.50 |
| D0220 |
Intraoral - periapical first radiographic image |
42 |
27 |
$195.84 |