| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,666 |
1,662 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
1,888 |
1,884 |
$44K |
| D1206 |
Topical application of fluoride varnish |
1,809 |
1,805 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
168 |
86 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,044 |
1,040 |
$19K |
| D1110 |
Prophylaxis - adult |
214 |
214 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
67 |
51 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
98 |
98 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
37 |
26 |
$3K |
| D2140 |
|
44 |
33 |
$3K |
| D2330 |
|
26 |
14 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
42 |
42 |
$2K |
| D0240 |
|
14 |
14 |
$308.00 |