| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,450 |
1,964 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
3,144 |
2,576 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,179 |
2,576 |
$61K |
| D1110 |
Prophylaxis - adult |
1,204 |
1,045 |
$60K |
| D0330 |
Panoramic radiographic image |
799 |
630 |
$45K |
| D0274 |
Bitewings - four radiographic images |
886 |
770 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
880 |
738 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
305 |
117 |
$21K |
| D1351 |
Sealant - per tooth |
545 |
38 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
121 |
81 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
51 |
38 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
199 |
166 |
$3K |
| D1320 |
|
64 |
55 |
$796.75 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
18 |
14 |
$539.00 |