| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,887 |
2,290 |
$93K |
| D1120 |
Prophylaxis - child |
3,517 |
2,894 |
$87K |
| D1206 |
Topical application of fluoride varnish |
3,287 |
2,744 |
$70K |
| D0330 |
Panoramic radiographic image |
569 |
406 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
377 |
360 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
303 |
213 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
164 |
38 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
42 |
15 |
$3K |