| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,421 |
1,278 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
1,519 |
1,367 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
803 |
757 |
$20K |
| D0330 |
Panoramic radiographic image |
872 |
834 |
$17K |
| D1110 |
Prophylaxis - adult |
371 |
367 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
784 |
728 |
$15K |
| D1206 |
Topical application of fluoride varnish |
756 |
640 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
377 |
374 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
104 |
94 |
$9K |
| D0274 |
Bitewings - four radiographic images |
529 |
494 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,362 |
1,221 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
117 |
93 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
788 |
718 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
180 |
150 |
$3K |
| D9110 |
|
41 |
40 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
31 |
26 |
$2K |
| D0272 |
Bitewings - two radiographic images |
95 |
91 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
15 |
12 |
$625.92 |
| D0270 |
|
41 |
41 |
$222.20 |