| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
524 |
473 |
$21K |
| D1206 |
Topical application of fluoride varnish |
514 |
463 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
181 |
142 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
342 |
305 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
395 |
375 |
$8K |
| D0274 |
Bitewings - four radiographic images |
246 |
230 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
110 |
85 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
579 |
524 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
702 |
450 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
172 |
156 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
124 |
122 |
$2K |
| D1110 |
Prophylaxis - adult |
89 |
89 |
$2K |
| D0330 |
Panoramic radiographic image |
75 |
72 |
$2K |
| D0272 |
Bitewings - two radiographic images |
138 |
126 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
15 |
13 |
$704.16 |
| D9310 |
|
16 |
16 |
$273.60 |