| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,958 |
1,947 |
$80K |
| D1120 |
Prophylaxis - child |
1,801 |
1,797 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
680 |
410 |
$45K |
| D1110 |
Prophylaxis - adult |
324 |
324 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,285 |
2,280 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
260 |
149 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
612 |
606 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
118 |
118 |
$8K |
| D0272 |
Bitewings - two radiographic images |
515 |
514 |
$6K |
| D1351 |
Sealant - per tooth |
240 |
65 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
140 |
137 |
$2K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$360.00 |