| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
348 |
343 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
265 |
170 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
143 |
143 |
$3K |
| D1110 |
Prophylaxis - adult |
80 |
80 |
$3K |
| D1206 |
Topical application of fluoride varnish |
166 |
166 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
307 |
304 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25 |
14 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
53 |
53 |
$763.48 |
| D0274 |
Bitewings - four radiographic images |
26 |
26 |
$709.38 |
| D1120 |
Prophylaxis - child |
15 |
15 |
$431.20 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15 |
15 |
$329.20 |
| D1330 |
|
64 |
64 |
$261.79 |
| D1310 |
|
24 |
24 |
$81.74 |