| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,272 |
1,217 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
1,277 |
1,225 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,253 |
1,198 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
184 |
117 |
$10K |
| D0274 |
Bitewings - four radiographic images |
553 |
519 |
$9K |
| D1110 |
Prophylaxis - adult |
211 |
198 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
309 |
293 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
295 |
279 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
67 |
52 |
$3K |
| D0272 |
Bitewings - two radiographic images |
373 |
358 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
510 |
479 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
44 |
39 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
106 |
99 |
$729.60 |