| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,172 |
7,991 |
$337K |
| D0120 |
Periodic oral evaluation - established patient |
8,284 |
8,098 |
$234K |
| D1206 |
Topical application of fluoride varnish |
3,621 |
3,530 |
$95K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
743 |
649 |
$56K |
| D0274 |
Bitewings - four radiographic images |
1,253 |
1,232 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,164 |
1,145 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
173 |
155 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
13 |
13 |
$910.35 |
| D1999 |
|
39 |
39 |
$0.00 |