| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
473 |
470 |
$11K |
| D1110 |
Prophylaxis - adult |
262 |
259 |
$10K |
| D2394 |
|
103 |
62 |
$7K |
| D0330 |
Panoramic radiographic image |
192 |
189 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
100 |
57 |
$6K |
| D1120 |
Prophylaxis - child |
123 |
122 |
$5K |
| D0272 |
Bitewings - two radiographic images |
262 |
259 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
186 |
185 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
42 |
25 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
16 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
25 |
$742.50 |