| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,190 |
1,189 |
$32K |
| D1110 |
Prophylaxis - adult |
556 |
556 |
$29K |
| D0272 |
Bitewings - two radiographic images |
999 |
998 |
$16K |
| D0330 |
Panoramic radiographic image |
379 |
377 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
109 |
82 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
124 |
63 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
321 |
318 |
$5K |
| D1120 |
Prophylaxis - child |
29 |
29 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
74 |
74 |
$992.60 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
13 |
$835.75 |
| D0230 |
Intraoral - periapical each additional radiographic image |
57 |
57 |
$754.90 |