| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,127 |
1,839 |
$109K |
| D0120 |
Periodic oral evaluation - established patient |
2,216 |
1,893 |
$52K |
| D1206 |
Topical application of fluoride varnish |
2,205 |
1,902 |
$35K |
| D0272 |
Bitewings - two radiographic images |
875 |
748 |
$16K |
| D7961 |
|
139 |
104 |
$12K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
152 |
26 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
779 |
674 |
$9K |
| D7962 |
|
76 |
70 |
$9K |
| D0330 |
Panoramic radiographic image |
115 |
99 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
438 |
338 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
89 |
29 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
119 |
108 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
102 |
81 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
46 |
13 |
$3K |
| D1110 |
Prophylaxis - adult |
38 |
32 |
$2K |