| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,148 |
1,127 |
$52K |
| D1120 |
Prophylaxis - child |
1,535 |
1,528 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,370 |
2,361 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
2,432 |
2,408 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
283 |
142 |
$25K |
| D0330 |
Panoramic radiographic image |
514 |
366 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
770 |
578 |
$18K |
| D0274 |
Bitewings - four radiographic images |
730 |
716 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
182 |
97 |
$13K |
| D9920 |
|
70 |
61 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
23 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
51 |
39 |
$447.20 |
| D0140 |
Limited oral evaluation - problem focused |
24 |
14 |
$347.62 |
| D1206 |
Topical application of fluoride varnish |
15 |
15 |
$311.85 |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$302.25 |