| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,289 |
2,162 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
2,417 |
2,262 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,194 |
2,070 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
825 |
789 |
$18K |
| D1110 |
Prophylaxis - adult |
486 |
459 |
$18K |
| D0274 |
Bitewings - four radiographic images |
942 |
892 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,001 |
1,864 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
167 |
143 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
229 |
193 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
262 |
251 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
439 |
410 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,712 |
1,591 |
$7K |
| D4341 |
|
22 |
12 |
$4K |
| D0272 |
Bitewings - two radiographic images |
306 |
287 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
15 |
12 |
$782.40 |
| D0270 |
|
73 |
72 |
$403.20 |