| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,988 |
1,606 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
1,453 |
1,114 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
522 |
195 |
$32K |
| D0274 |
Bitewings - four radiographic images |
824 |
668 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,242 |
1,028 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
565 |
444 |
$19K |
| D0330 |
Panoramic radiographic image |
461 |
368 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
371 |
318 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
563 |
440 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
82 |
39 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
108 |
27 |
$965.58 |
| D0272 |
Bitewings - two radiographic images |
28 |
26 |
$539.42 |