| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
558 |
533 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
582 |
556 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
258 |
236 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
83 |
74 |
$6K |
| D1206 |
Topical application of fluoride varnish |
175 |
175 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
183 |
181 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
489 |
471 |
$3K |
| D1110 |
Prophylaxis - adult |
56 |
54 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
53 |
49 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
69 |
67 |
$2K |
| D0274 |
Bitewings - four radiographic images |
108 |
107 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
422 |
402 |
$2K |
| D0272 |
Bitewings - two radiographic images |
107 |
105 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
13 |
$784.72 |