| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,036 |
5,039 |
$129K |
| D0140 |
Limited oral evaluation - problem focused |
4,772 |
3,393 |
$114K |
| D0120 |
Periodic oral evaluation - established patient |
4,077 |
3,694 |
$91K |
| D1206 |
Topical application of fluoride varnish |
4,786 |
3,918 |
$85K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,085 |
380 |
$75K |
| D0330 |
Panoramic radiographic image |
1,800 |
1,456 |
$62K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
678 |
171 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,426 |
905 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,386 |
1,097 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
870 |
801 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,105 |
789 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
69 |
63 |
$4K |
| D0274 |
Bitewings - four radiographic images |
29 |
24 |
$831.24 |