| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
976 |
975 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,128 |
1,122 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
998 |
997 |
$24K |
| D1110 |
Prophylaxis - adult |
356 |
351 |
$14K |
| D0274 |
Bitewings - four radiographic images |
647 |
642 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
233 |
156 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
394 |
392 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
881 |
871 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
83 |
65 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
284 |
276 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
717 |
631 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
67 |
43 |
$4K |
| D0272 |
Bitewings - two radiographic images |
264 |
263 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
33 |
27 |
$2K |
| D0330 |
Panoramic radiographic image |
23 |
23 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
96 |
95 |
$894.50 |