| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,800 |
1,073 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
1,387 |
1,034 |
$57K |
| D0140 |
Limited oral evaluation - problem focused |
1,362 |
533 |
$42K |
| D1120 |
Prophylaxis - child |
754 |
445 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
520 |
266 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
536 |
231 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
314 |
172 |
$13K |
| D0274 |
Bitewings - four radiographic images |
293 |
267 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
151 |
73 |
$8K |
| D1206 |
Topical application of fluoride varnish |
212 |
212 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
260 |
259 |
$3K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$242.18 |
| D1999 |
|
48 |
47 |
$0.00 |
| D1310 |
|
17 |
17 |
$0.00 |
| D0601 |
|
12 |
12 |
$0.00 |