| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,544 |
2,449 |
$89K |
| D0330 |
Panoramic radiographic image |
1,387 |
1,322 |
$76K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
587 |
337 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
1,822 |
1,734 |
$51K |
| D1110 |
Prophylaxis - adult |
979 |
933 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,292 |
2,203 |
$46K |
| D0272 |
Bitewings - two radiographic images |
1,167 |
1,108 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
369 |
321 |
$16K |
| D1206 |
Topical application of fluoride varnish |
391 |
386 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
110 |
71 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
13 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
133 |
111 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
26 |
26 |
$345.00 |