| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,092 |
864 |
$832.44 |
| D0120 |
Periodic oral evaluation - established patient |
1,266 |
1,027 |
$769.50 |
| D1206 |
Topical application of fluoride varnish |
1,410 |
1,127 |
$489.72 |
| D0274 |
Bitewings - four radiographic images |
790 |
641 |
$461.70 |
| D0220 |
Intraoral - periapical first radiographic image |
1,741 |
1,431 |
$314.82 |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,401 |
1,041 |
$215.71 |
| D0272 |
Bitewings - two radiographic images |
456 |
350 |
$179.52 |
| D0603 |
|
295 |
254 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
258 |
128 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
219 |
183 |
$0.00 |
| D0601 |
|
361 |
292 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
147 |
102 |
$0.00 |
| D0602 |
|
78 |
56 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
135 |
66 |
$0.00 |
| D1110 |
Prophylaxis - adult |
165 |
141 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
81 |
46 |
$0.00 |
| D0330 |
Panoramic radiographic image |
50 |
41 |
$0.00 |