| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
835 |
765 |
$27K |
| D1110 |
Prophylaxis - adult |
470 |
458 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
425 |
421 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
160 |
76 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
591 |
561 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
121 |
119 |
$8K |
| D4910 |
|
94 |
94 |
$6K |
| D0274 |
Bitewings - four radiographic images |
160 |
157 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
193 |
189 |
$4K |
| D1206 |
Topical application of fluoride varnish |
199 |
197 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
55 |
13 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21 |
12 |
$3K |
| D0350 |
|
214 |
211 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13 |
12 |
$178.92 |
| D9986 |
|
271 |
249 |
$0.00 |