| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
159 |
155 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
208 |
202 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
155 |
151 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
152 |
150 |
$3K |
| D0274 |
Bitewings - four radiographic images |
169 |
165 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
40 |
29 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
33 |
14 |
$2K |
| D1110 |
Prophylaxis - adult |
68 |
65 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
272 |
260 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
232 |
199 |
$1K |
| D0272 |
Bitewings - two radiographic images |
29 |
29 |
$272.60 |
| D0140 |
Limited oral evaluation - problem focused |
16 |
13 |
$210.60 |