| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
593 |
584 |
$14K |
| D1120 |
Prophylaxis - child |
414 |
404 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
664 |
654 |
$13K |
| D1110 |
Prophylaxis - adult |
310 |
307 |
$12K |
| D0274 |
Bitewings - four radiographic images |
396 |
393 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
87 |
45 |
$6K |
| D0272 |
Bitewings - two radiographic images |
292 |
286 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
74 |
48 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
74 |
37 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
103 |
100 |
$3K |
| D0330 |
Panoramic radiographic image |
79 |
79 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
80 |
75 |
$930.13 |
| D0140 |
Limited oral evaluation - problem focused |
27 |
26 |
$508.32 |