| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
459 |
348 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
243 |
102 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
195 |
115 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
480 |
389 |
$12K |
| D0330 |
Panoramic radiographic image |
629 |
447 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
392 |
303 |
$9K |
| D1110 |
Prophylaxis - adult |
228 |
177 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
347 |
288 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
410 |
277 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
78 |
52 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
751 |
545 |
$3K |
| D0274 |
Bitewings - four radiographic images |
124 |
111 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
161 |
119 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
37 |
26 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
557 |
350 |
$1K |
| D1206 |
Topical application of fluoride varnish |
53 |
35 |
$1K |