| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,192 |
1,128 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,505 |
1,429 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,070 |
1,013 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
282 |
164 |
$25K |
| D0274 |
Bitewings - four radiographic images |
509 |
484 |
$18K |
| D1110 |
Prophylaxis - adult |
418 |
395 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
437 |
383 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
106 |
68 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
471 |
408 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
68 |
42 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
81 |
75 |
$4K |
| D0272 |
Bitewings - two radiographic images |
89 |
82 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
45 |
42 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
25 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17 |
15 |
$148.24 |