| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,230 |
2,025 |
$57K |
| D0330 |
Panoramic radiographic image |
958 |
857 |
$43K |
| D1206 |
Topical application of fluoride varnish |
1,732 |
1,582 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
807 |
762 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,289 |
1,135 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
763 |
663 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
364 |
181 |
$26K |
| D1351 |
Sealant - per tooth |
513 |
99 |
$13K |
| D0274 |
Bitewings - four radiographic images |
216 |
190 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
42 |
37 |
$775.95 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$706.38 |
| D0220 |
Intraoral - periapical first radiographic image |
27 |
26 |
$329.42 |