| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
328 |
316 |
$7K |
| D1110 |
Prophylaxis - adult |
208 |
202 |
$7K |
| D9110 |
|
106 |
92 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
106 |
39 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
140 |
122 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
162 |
158 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
34 |
27 |
$2K |
| D1206 |
Topical application of fluoride varnish |
89 |
88 |
$1K |
| D1120 |
Prophylaxis - child |
44 |
44 |
$1K |
| D0330 |
Panoramic radiographic image |
36 |
35 |
$860.42 |
| D0274 |
Bitewings - four radiographic images |
87 |
83 |
$842.97 |
| D0220 |
Intraoral - periapical first radiographic image |
67 |
62 |
$426.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$324.48 |