| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
709 |
667 |
$51K |
| D1120 |
Prophylaxis - child |
470 |
455 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
116 |
89 |
$14K |
| D0999 |
Unspecified diagnostic procedure, by report |
141 |
118 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
89 |
88 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
78 |
64 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
374 |
368 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
87 |
82 |
$7K |
| D0274 |
Bitewings - four radiographic images |
66 |
65 |
$5K |
| D0272 |
Bitewings - two radiographic images |
69 |
66 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
15 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
15 |
14 |
$1K |