| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
1,487 |
1,478 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,460 |
1,452 |
$24K |
| D1120 |
Prophylaxis - child |
776 |
771 |
$24K |
| D1110 |
Prophylaxis - adult |
638 |
633 |
$23K |
| D9630 |
|
781 |
772 |
$12K |
| D0274 |
Bitewings - four radiographic images |
400 |
397 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
63 |
41 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
128 |
128 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
246 |
233 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
102 |
99 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
13 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
37 |
37 |
$2K |
| D0272 |
Bitewings - two radiographic images |
55 |
55 |
$1K |