| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
344 |
327 |
$24K |
| D1120 |
Prophylaxis - child |
390 |
364 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
196 |
185 |
$14K |
| D0999 |
Unspecified diagnostic procedure, by report |
1,093 |
868 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
26 |
26 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
224 |
208 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
132 |
117 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
169 |
147 |
$975.19 |
| D0274 |
Bitewings - four radiographic images |
207 |
195 |
$554.65 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$9.40 |
| D1206 |
Topical application of fluoride varnish |
15 |
15 |
$0.00 |