| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,737 |
1,737 |
$43K |
| D1110 |
Prophylaxis - adult |
392 |
392 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
431 |
428 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
77 |
64 |
$4K |
| D1206 |
Topical application of fluoride varnish |
888 |
884 |
$4K |
| D4341 |
|
152 |
66 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
70 |
52 |
$2K |
| D4346 |
|
67 |
67 |
$2K |
| D0330 |
Panoramic radiographic image |
315 |
315 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
25 |
$1K |
| D1120 |
Prophylaxis - child |
39 |
39 |
$566.80 |
| D0120 |
Periodic oral evaluation - established patient |
17 |
17 |
$149.39 |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
15 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
41 |
41 |
$0.00 |
| D1330 |
|
14 |
14 |
$0.00 |
| D0350 |
|
13 |
13 |
$0.00 |