| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
646 |
625 |
$43K |
| D1120 |
Prophylaxis - child |
550 |
541 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
445 |
416 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
71 |
71 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
123 |
66 |
$3K |
| D0272 |
Bitewings - two radiographic images |
308 |
291 |
$2K |
| D1110 |
Prophylaxis - adult |
27 |
27 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
27 |
26 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
16 |
15 |
$981.81 |
| D1206 |
Topical application of fluoride varnish |
204 |
199 |
$109.09 |
| D0603 |
|
18 |
18 |
$0.00 |