| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
639 |
619 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
913 |
887 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
564 |
555 |
$14K |
| D0274 |
Bitewings - four radiographic images |
475 |
466 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
78 |
65 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
683 |
649 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
149 |
146 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
522 |
482 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
45 |
28 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
124 |
117 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
55 |
44 |
$2K |
| D1110 |
Prophylaxis - adult |
45 |
45 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
30 |
28 |
$413.33 |
| D0272 |
Bitewings - two radiographic images |
40 |
40 |
$399.45 |
| D0270 |
|
14 |
14 |
$78.40 |
| D1999 |
|
142 |
137 |
$0.00 |