| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,877 |
2,784 |
$116K |
| D0120 |
Periodic oral evaluation - established patient |
3,127 |
3,003 |
$85K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,611 |
2,525 |
$67K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
382 |
265 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,092 |
1,072 |
$24K |
| D0274 |
Bitewings - four radiographic images |
1,294 |
1,244 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
3,195 |
3,039 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,673 |
2,474 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
367 |
262 |
$13K |
| D1110 |
Prophylaxis - adult |
263 |
256 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
341 |
337 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
614 |
593 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
123 |
94 |
$7K |
| D0272 |
Bitewings - two radiographic images |
226 |
216 |
$2K |