| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
250 |
228 |
$10K |
| D0330 |
Panoramic radiographic image |
223 |
201 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
70 |
41 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
405 |
360 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
218 |
105 |
$3K |
| D0274 |
Bitewings - four radiographic images |
79 |
76 |
$2K |
| D1206 |
Topical application of fluoride varnish |
156 |
149 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
15 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
43 |
43 |
$1K |
| D1120 |
Prophylaxis - child |
31 |
31 |
$875.10 |
| D1110 |
Prophylaxis - adult |
15 |
13 |
$543.66 |
| D0140 |
Limited oral evaluation - problem focused |
15 |
12 |
$428.96 |