| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,415 |
1,413 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
1,386 |
1,384 |
$44K |
| D1206 |
Topical application of fluoride varnish |
1,471 |
1,470 |
$39K |
| D0272 |
Bitewings - two radiographic images |
900 |
900 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
72 |
57 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
356 |
352 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
78 |
66 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
67 |
67 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
35 |
26 |
$3K |
| D0240 |
|
66 |
41 |
$1K |