| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
748 |
735 |
$30K |
| D1120 |
Prophylaxis - child |
747 |
734 |
$21K |
| D1206 |
Topical application of fluoride varnish |
613 |
600 |
$13K |
| D0330 |
Panoramic radiographic image |
347 |
340 |
$12K |
| D0272 |
Bitewings - two radiographic images |
642 |
627 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
253 |
233 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
96 |
61 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
73 |
73 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
27 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
189 |
170 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
14 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
32 |
32 |
$542.50 |