| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
918 |
892 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
937 |
895 |
$24K |
| D1206 |
Topical application of fluoride varnish |
877 |
852 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
142 |
87 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
146 |
99 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,018 |
976 |
$6K |
| D0274 |
Bitewings - four radiographic images |
320 |
302 |
$5K |
| D0272 |
Bitewings - two radiographic images |
448 |
433 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
982 |
928 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
68 |
45 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
53 |
46 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
103 |
100 |
$2K |
| D1110 |
Prophylaxis - adult |
63 |
55 |
$2K |
| D2335 |
|
13 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
50 |
49 |
$761.40 |
| D0270 |
|
86 |
80 |
$453.60 |