| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
302 |
270 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
331 |
300 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
291 |
259 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
134 |
80 |
$6K |
| D0274 |
Bitewings - four radiographic images |
126 |
115 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
23 |
18 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
127 |
108 |
$2K |
| D1110 |
Prophylaxis - adult |
41 |
39 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
186 |
155 |
$924.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
13 |
$914.85 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
43 |
37 |
$820.95 |
| D0272 |
Bitewings - two radiographic images |
52 |
42 |
$460.60 |