| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,418 |
1,389 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,234 |
1,206 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,452 |
1,415 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
389 |
378 |
$14K |
| D0272 |
Bitewings - two radiographic images |
520 |
506 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
653 |
622 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
88 |
38 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
355 |
311 |
$3K |
| D9420 |
|
43 |
41 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
76 |
76 |
$1K |
| D0240 |
|
32 |
30 |
$712.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$354.20 |