| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,997 |
2,892 |
$78K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,247 |
515 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
3,885 |
3,779 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,210 |
4,033 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
923 |
362 |
$45K |
| D1110 |
Prophylaxis - adult |
1,280 |
1,210 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,412 |
1,363 |
$22K |
| D0330 |
Panoramic radiographic image |
648 |
577 |
$21K |
| D0274 |
Bitewings - four radiographic images |
581 |
532 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
479 |
422 |
$8K |
| D1206 |
Topical application of fluoride varnish |
477 |
459 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
226 |
197 |
$5K |
| D1999 |
|
697 |
597 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
52 |
32 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
25 |
$1K |