| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,900 |
5,698 |
$302K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,053 |
5,804 |
$165K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,068 |
7,759 |
$122K |
| D0272 |
Bitewings - two radiographic images |
6,809 |
6,541 |
$109K |
| D0330 |
Panoramic radiographic image |
1,728 |
1,649 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
3,176 |
3,062 |
$68K |
| D1110 |
Prophylaxis - adult |
1,218 |
1,153 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
324 |
236 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
215 |
149 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
706 |
683 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
145 |
89 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
50 |
39 |
$477.75 |