| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,141 |
3,089 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,654 |
3,601 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
3,189 |
3,145 |
$57K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
479 |
303 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,434 |
1,411 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
171 |
171 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
68 |
54 |
$4K |
| D1110 |
Prophylaxis - adult |
97 |
97 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
94 |
93 |
$470.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$60.00 |
| D1999 |
|
15 |
15 |
$0.00 |