| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
916 |
817 |
$34K |
| D1110 |
Prophylaxis - adult |
605 |
596 |
$31K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
43 |
14 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
86 |
84 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
148 |
146 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
189 |
189 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
13 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
67 |
65 |
$931.00 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$459.00 |