| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
3,124 |
1,045 |
$50.74 |
| D1120 |
Prophylaxis - child |
3,434 |
1,211 |
$31.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
3,439 |
1,213 |
$17.00 |
| D0330 |
Panoramic radiographic image |
895 |
268 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
676 |
224 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
158 |
13 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
1,173 |
351 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,622 |
1,268 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
690 |
196 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
481 |
44 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
41 |
13 |
$0.00 |