| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
145 |
51 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
172 |
167 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
48 |
26 |
$5K |
| D0330 |
Panoramic radiographic image |
148 |
147 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
75 |
75 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
45 |
45 |
$3K |
| D1120 |
Prophylaxis - child |
70 |
69 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
428 |
203 |
$2K |
| D0272 |
Bitewings - two radiographic images |
72 |
72 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
65 |
64 |
$1K |
| D0274 |
Bitewings - four radiographic images |
75 |
73 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
46 |
44 |
$481.14 |
| D1999 |
|
17 |
15 |
$0.00 |