| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,277 |
1,267 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
2,029 |
2,008 |
$31K |
| D9630 |
|
1,889 |
1,871 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
498 |
490 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
843 |
833 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
265 |
160 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
139 |
106 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
125 |
85 |
$4K |
| D1206 |
Topical application of fluoride varnish |
225 |
224 |
$4K |
| D0330 |
Panoramic radiographic image |
45 |
45 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
28 |
27 |
$301.86 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$0.00 |
| D1110 |
Prophylaxis - adult |
28 |
28 |
$0.00 |