| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
402 |
389 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
535 |
517 |
$14K |
| D1110 |
Prophylaxis - adult |
260 |
250 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
142 |
100 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
111 |
87 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
305 |
294 |
$6K |
| D0274 |
Bitewings - four radiographic images |
357 |
350 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
177 |
170 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
508 |
491 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
115 |
111 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
440 |
413 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
49 |
33 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
33 |
33 |
$518.40 |
| D0272 |
Bitewings - two radiographic images |
53 |
52 |
$479.40 |