| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
2,982 |
1,877 |
$95K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
583 |
195 |
$66K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
668 |
205 |
$54K |
| D1120 |
Prophylaxis - child |
1,145 |
954 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,150 |
957 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,854 |
934 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
511 |
481 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
329 |
210 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
77 |
24 |
$4K |
| D0272 |
Bitewings - two radiographic images |
215 |
183 |
$3K |
| D2331 |
|
27 |
13 |
$2K |
| D2330 |
|
21 |
14 |
$1K |
| D0330 |
Panoramic radiographic image |
27 |
25 |
$891.93 |