| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,033 |
1,015 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,303 |
1,282 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,905 |
1,877 |
$27K |
| D1110 |
Prophylaxis - adult |
457 |
454 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
509 |
508 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
296 |
152 |
$11K |
| D0330 |
Panoramic radiographic image |
187 |
186 |
$7K |
| D0274 |
Bitewings - four radiographic images |
196 |
195 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
91 |
74 |
$5K |
| D0272 |
Bitewings - two radiographic images |
79 |
78 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
32 |
32 |
$924.30 |
| D1999 |
|
13 |
13 |
$0.00 |