| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
843 |
830 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
843 |
825 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
802 |
792 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
312 |
225 |
$13K |
| D0274 |
Bitewings - four radiographic images |
372 |
357 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
262 |
252 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
87 |
68 |
$5K |
| D1110 |
Prophylaxis - adult |
165 |
152 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
86 |
63 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
167 |
159 |
$2K |
| D0272 |
Bitewings - two radiographic images |
259 |
252 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
378 |
357 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
33 |
29 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
131 |
125 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
13 |
12 |
$533.40 |
| D2140 |
|
17 |
15 |
$493.60 |