| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,584 |
1,434 |
$43K |
| D0330 |
Panoramic radiographic image |
954 |
857 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,000 |
919 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
1,008 |
792 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,545 |
1,365 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
123 |
76 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
440 |
360 |
$11K |
| D0274 |
Bitewings - four radiographic images |
367 |
323 |
$8K |
| D0272 |
Bitewings - two radiographic images |
280 |
241 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
75 |
44 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
97 |
86 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
45 |
26 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
176 |
95 |
$992.02 |
| D1208 |
Topical application of fluoride, excluding varnish |
42 |
25 |
$595.60 |
| D1999 |
|
573 |
467 |
$0.00 |
| D9987 |
|
47 |
36 |
$0.00 |
| D9986 |
|
223 |
195 |
$0.00 |