| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,340 |
1,248 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
1,552 |
1,441 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
267 |
176 |
$33K |
| D1120 |
Prophylaxis - child |
340 |
325 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
319 |
106 |
$11K |
| D0274 |
Bitewings - four radiographic images |
299 |
271 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
197 |
188 |
$8K |
| D1206 |
Topical application of fluoride varnish |
232 |
217 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
218 |
206 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
161 |
155 |
$5K |
| D0180 |
|
53 |
44 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
16 |
12 |
$570.96 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$388.20 |
| D0220 |
Intraoral - periapical first radiographic image |
18 |
14 |
$268.40 |
| D1999 |
|
149 |
143 |
$0.00 |
| D0601 |
|
567 |
531 |
$0.00 |