| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,840 |
1,840 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
2,582 |
2,582 |
$54K |
| D1110 |
Prophylaxis - adult |
1,085 |
1,085 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,917 |
2,917 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
602 |
268 |
$40K |
| D0330 |
Panoramic radiographic image |
775 |
775 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
1,098 |
1,060 |
$32K |
| D0274 |
Bitewings - four radiographic images |
918 |
918 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
296 |
296 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
129 |
91 |
$7K |
| D1351 |
Sealant - per tooth |
241 |
59 |
$5K |
| D0272 |
Bitewings - two radiographic images |
299 |
299 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
290 |
278 |
$4K |
| D1206 |
Topical application of fluoride varnish |
40 |
40 |
$736.85 |