| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,358 |
1,283 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
914 |
865 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,243 |
1,178 |
$29K |
| D0145 |
Oral evaluation for a patient under three years of age |
417 |
403 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
609 |
586 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
252 |
242 |
$18K |
| D0272 |
Bitewings - two radiographic images |
606 |
575 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
424 |
407 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
27 |
13 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
32 |
13 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
140 |
123 |
$2K |