| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,627 |
1,378 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
611 |
516 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,183 |
1,854 |
$31K |
| D1110 |
Prophylaxis - adult |
835 |
708 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
1,765 |
1,525 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
865 |
716 |
$20K |
| D0330 |
Panoramic radiographic image |
641 |
513 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
299 |
241 |
$7K |
| D0274 |
Bitewings - four radiographic images |
518 |
409 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
134 |
45 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
133 |
91 |
$5K |
| D0272 |
Bitewings - two radiographic images |
403 |
351 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
63 |
51 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
52 |
52 |
$499.62 |
| D9999 |
Unspecified adjunctive procedure, by report |
30 |
22 |
$0.00 |