| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,739 |
2,655 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,224 |
2,120 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
2,369 |
2,285 |
$38K |
| D1110 |
Prophylaxis - adult |
1,097 |
1,080 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
448 |
237 |
$15K |
| D0274 |
Bitewings - four radiographic images |
836 |
823 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
304 |
284 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
68 |
40 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
442 |
405 |
$4K |
| D0272 |
Bitewings - two radiographic images |
316 |
312 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
81 |
36 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
39 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
54 |
54 |
$596.48 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,483 |
1,470 |
$0.00 |